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The Future of the Health Record and Interoperability


The way the meaningful use program was structured was more about the adoption of electronic health records and not interoperability, and in order to get there, the US health system needs to first understand what it wants interoperability to do.

The way the meaningful use program was structured was more about the adoption of electronic health records (EHRs) and not interoperability, and so the US health system has grown into many different EHR systems that cannot talk to one another, explained Doug Fridsma, MD, PhD, president and CEO of the American Medical Informatics Association, at the Annual Meeting of the Pharmacy Quality Alliance.

After the program was created, the country went from a 17% adoption rate to well over 90% in academic centers and close to it in smaller practices, he said. Health information technology (IT) should be looked at as an ultra large scale system because the EHRs and systems are out there but they still need to be able to exchange information.

“Ultra large scale systems are always going to be de-centrally controlled,” Fridsma said. “We really have to think about this as pharmacists and nurses and doctors all working together.” And at the center of the system is the patient.

He went on to explain that interoperability is defined by 2 things:

  1. The ability of 2 or more systems to exchange information
  2. The ability of those systems to use the information that has been exchanged

In order for interoperability to work, we need to know what we want it to do so we can measure and get there, he added. And ultimately, the goal should be to get to a learning health system, where every interaction with the system provides a better way to do things.

There are still things to fix in regards to EHRs, according to Fridsma, such as simplifying documentation; focusing regulation; increasing transparency—in order to improve the systems and see what is working; encouraging innovation; and keeping the patient at the center.

Going forward, Fridsma does not expect EHRs to be the most important health IT, and he even likened it to the physician’s automobile, which had been touted as the new technology for physicians, but went away in just a few years.

“It’s going to stop being the electronic health record and just be the health record,” Fridsma said. “That will be how we store it.”

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