Lack Of Data Standard, Not Meaningful Use To Blame For Crap EHR Systems

Meaninful Use and EHRs

Let’s not blame the carrot (Meaningful use) for the stick (Electronic Health Record systems) being too short!

If we want to make Electronic Health Record systems (and Practice Management systems) better, cheaper and actually innovate, then we need a standard schema for how core data is stored so that it can be easily exported to a different EHR at the drop of a hat.

Despite the availability of $35 billion of federal funding to incentivize the adoption of this new health information technology, results have been disappointing.  For one thing, physicians, nurses, and other health professionals who rely on such systems on a daily basis reported steadily decreasing levels of satisfaction with them.  The move to electronic records has not only failed to enhance patient care but in many cases actually interfered with it.

Meaningful use isn’t the reason that EHR systems are so fundamentally crappy and exorbitantly expensive, it’s that once you sign a contract vendors know you’re going to be with them for 5 – 10 years because an automatic lock-in is created by the prohibitive costs related to implementation, staff training and patient data transfer.

Sure, there are standards for interoperability, but as far as I can tell there are no standards defining how these companies actually store the patient data within their systems. Or, if we feel this is too much of an imposition, standards defining a schema for importing and exporting of information from the system (what they do with it in their system is their own business).

There are criteria for a data export for a certified EHR but of course they fall short of providing a real solution:

We also note that this functionality is not intended to and may not be sufficient to accomplish a full migration from one product to another without additional intervention because of the scope of this criterion. Specifically, the data and document templates specified in this criterion would not likely support a full migration, which could include administrative data such as billing information. The criterion’s functionality could, however, support the migration of clinical data between health IT systems and can play a role in expediting such an activity if so determined by the user.

This leads to very expensive and time-consuming conversion processes, which usually results in only a partial import of the data your practice needs being imported.

I recently handled a migration from a well established server-based product to one of the largest cloud based providers. Much to my frustration even a basic list of referring providers couldn’t be exported from one and imported to the other without connecting directly to the SQL database, exporting the data, then reformatting to match the new vendors schema, manually creating some data columns that couldn’t be reliably split programmatically and uploading to the new vendor.

The patient demographics were a considerably larger nightmare.

We could have paid the vendor to do it but that would have taken longer than doing it myself and would have cost considerably more.

A defined standard for core data portability would make it incredibly easy to demo solutions from vendors as you could import data into a test environment, evaluate the system with real patient data instead of the often useless test data many vendors load into their demos, and enable practices to make better informed decisions about which solution to invest in.

Needless to say data portability would increase competition between vendors essentially forcing them to focus on what practices actually need, delivering better user interfaces, improved user experiences and lower costs – all of which adds up to products that are easier to use, cost less and create more time for physicians and their staff to actually focus on patients.