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Towards Healthcare Interoperability: What Must Be Done?
November 09, 2015

Towards Healthcare Interoperability: What Must Be Done?

Howard Chen is a radiology chief resident at University of Pennsylvania in the Healthcare Quality and Leadership pathway. Howard graduated from Harvard Medical School and Harvard Business School and was the recipient of the 2014 Imaging Informatics Open-Source Leadership Award from the Society of Imaging Informatics in Medicine. His peer-reviewed papers investigate the role of data science in patient care, radiology education, and computational genomics. Howard writes about creating value for patient care through informatics and innovation. He tweets under @howardpchen.
Open Standards Is Just the Beginning

One well-known example of open standard in healthcare is Digital Imaging and Communications in Medicine (DICOM) standard, developed to handle, store, and transmit medical imaging. DICOM allows a magnetic resonance imaging scan from anywhere in the United States to be assimilated into any other radiology system. Another such example is HL7, which standardizes how healthcare data can stream between software applications. Related to HL7 is FHIR (pronounced “fire”), aimed for rapid interchange of interoperable, granular clinical data components.

With open industry standards, so long as the vendor supports the proper standards, it would be able to send data to or receive data from another system that supports the standards regardless of which EHR vendor the 2 systems choose.

Like its competitors, Epic Systems Corporation began to recognize the importance of making healthcare data universally available. Its EHR supports many open standards including both DICOM and HL7. Nevertheless, a 2014 RAND report describes Epic's low interoperability as a major concern. The report cites that Epic's heavy customization for each implementation and its heavy reliance on free-text fields create “closed records.” Due to these reasons, not all implementations of Epic are necessarily compatible with one another. One Black Book poll for hospital EHR usability found Epic users were "most dissatisfied with the inability to integrate with best of breed [emergency department information system] solutions (86%) or provide widespread connectivity to obtain external records (83%).”


As Walgreens joins the many thousands of institutions who made the transition to EHR for interoperability, the verdict is still pending on the best way to achieve health IT's new holy grail. While proprietary solutions align powerful market forces with patient interest, the reality of healthcare's complexity will require all the major players to work together and agree on an open format.

Next time your clinic or hospital wants to buy a new EHR, take the opportunity to ask about how well it plays the other EHRs in your city. It is the least you can do to help your patients consolidate their dental, physical therapy or rehabilitation, and nursing home records for the best experience.

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