The goal of an electronic health record (EHR) system is to capture the health information about individual patients over time and store and retrieve that information accurately. Digital formats offer greater efficiency and reduced probability of error compared with paper medical records, whose accuracy and legibility may not be as good. Data is also less likely to be lost and easier to keep updated and search. Consequently, EHR systems (also simply referred to as “EHRs”) make it easier to compare and analyze data to reveal trends and longer-term changes for a given patient. Collectively, electronic health records can also help to study group and population health phenomena.
It makes sense for EHR management systems to standardize the format of the records they hold, to make them easier to consult and share with other authorized entities. Likewise, the software and network interfaces in such a software system are also best standardized or at least made customizable to allow for connection to legacy systems and non-standard interfaces.
When Customization Wins Over Standardization
However, things have often turned out differently. The universal EHR system is often more a vision than a reality, for two reasons:
- Individual healthcare organizations function differently. In addition, many first-generation EHR systems were built to meet the requirements of primary care physicians, ignoring other functionality of interest to medical specialists.
- When non-customized EHR systems were used, caregivers often felt they were being obliged to adapt to the solution, causing extra work. This led to negative effects in the form of degraded communication, loss of productivity and missing records. Customization of the EHR software to specific needs and workflows was then often seen as the way to recover the promised benefits.
The Impact of HITECH and HIPAA
The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act offers federal incentives to adopt EHR use. This is done through criteria for “meaningful use” including usage leading to increased efficiency and reduced costs (use of EHRs for e-prescribing, for example). However, federal agencies and healthcare providers l need to juggle the following requirements to ready their EHR systems for the future, while satisfying conditions for receiving “meaningful use” incentives:
- Implementation of accepted standards for transmitting patient data. One possible example is HL7, a standardized messaging and text communications protocol between practice management systems, and between hospital and physician record systems. Others include DICOM, an international communications protocol standard for displaying and communicating image data (for instance, for radiology), and the X12 electronic data interchange (EDI) protocol that is popular in the United States for the transmission of billing data.
- Initial EHR adoption rates were slower than expected in the United States, compared to other developed countries. The cost and the effort needed to start using an EHR system were contributing factors, but so was a lack of user-friendliness. Since then, caregivers have rapidly adopted mobile computing (smartphones and tablets), which often offer the possibility to connect to and sync with EHR systems, either locally or remotely. IT teams will, therefore, need to manage this mobility and put suitable BYOD (bring your own device) policies in place, as needed.
- The 1996 Health Insurance Portability and Accountability Act (HIPAA) lays down rules for authentication, access, storage, transmission and auditing of electronic health records. However, as recent data breaches have shown that HIPAA stipulations may be necessary, but not sufficient. For example, the lack of encryption of data breached in health insurer Anthem’s systems in 2015 was not contrary to HIPAA rules, but was publicly criticized by different observers.
- Customers for EHR systems worry that they will pick the wrong system, whether in terms of costs (acquisition and maintenance), disruptions to productivity, lack of user acceptance and adoption, or available skills to run and maintain the system. Some have suggested that the government should fund research into new, improved systems to be made available as open-source (essentially free) software to end-users of EHR systems.
Roles for IT Teams
IT teams will have several roles to play, from technical experts (EHR interchange standards and security) to trusted technical-business advisor (system selection to meet caregiver, operational and usability goals). In addition, IT teams can help EHR system acquirers to better returns on their investments by advising on value-added extensions, such as decision support applications to leverage the data held in the electronic health records. They may then also supervise or undertake the implementation of such extensions.