EMR Integration: A New Frontier of Healthcare Pain Management

Mary E. Shacklett, President, Transworld Data | 9/30/2011 | 8 comments

Mary E. Shacklett
“We have $100,000 in our budget just to look at EMR integration,” said a noted surgeon sitting on a committee for EMR (electronic medical record) integration at a large West Coast medical center. “It is unbelievable for me to think about that kind of money for a study, but a colleague in another hospital system recently told me that they were already into the billions of dollars in their quest for EMR integration.”

There is no doubt about it -- EMR integration is dealing out major pain to healthcare institutions as they march forward to meet federal mandates for EMR implementation. They must also contemplate how they will integrate the EMRs of other healthcare institutions, especially during mergers.

“We’d already conceded that the problem of total EMR integration was too large for us to solve in either a single year, or in several years,” said the surgeon. “That’s why when we made the decision to merge with another major healthcare institution, we also determined at the same time that they would continue to run on their own EMR and we would continue to use ours.”

There is only so long that this policy of expediency in mergers can work, however. Sooner or later, patients (and their attending medical staffs) will wonder why records stored with an eye clinic in one facility cannot easily be electronically accessed by the patients’ cardiologists in another building. The process can end up being even more painful than simply moving manual medical records through internal delivery systems.

For healthcare IT, the EMR integration problem is even more excruciating -- since the end users (medical staff and their patients) only see the “skin” of the issue. The “bone deep” issues of disparate data bases and data structures, vendor-specific applications, multiple hardware and software platforms (and licenses), and vendor cooperation are even more daunting. It renders the task of integrating multiple EMR systems into a single, final, user-friendly solution extremely difficult.

The federal government has recognized this, and as part of its healthcare stimulus and EMR implementation program has created committees that are forcing both healthcare institutions and (most importantly) healthcare EMR vendors to come together on the design of industry-standard APIs (application programming interfaces) that will allow systems to cross-communicate with each other.

“Since the federal government has gotten involved, I have really seen a difference in the ability to move forward with EMR integration,” said one Iowa healthcare systems administrator. “However, there is still major work ahead. Unless all of the EMR vendors agree to universal data structures, there is still great pain in trying to move data from one set of data structures in one system to an entirely different set of data structures in a second system.”

This is the picture that IT sees -- and that is difficult to explain to many healthcare business executives who don’t understand the technical problem as well as the Iowa administrator does. The data structure issues directly pit universal electronic medical records against the self-interests of EMR vendors that don’t want to “match up” with each other for fear of losing market share.

So what do you do if you’re in healthcare IT?

  • Make sure that IT is high on any merger checklist your institution has when it goes out to consider possible acquisition targets. The cost of a major EMR integration effort is hard to overestimate.

  • If there is an EMR integration problem, take the time to educate management on why there's a problem and what it's going to take to fix it.

  • If you’re forced into a situation where you have to use and manage multiple EMR systems, consider building a GUI (graphical user interface) where medical staff can at least access the information on either system with appropriate security levels and the click of a mouse.

  • Decide on a single EMR solution and work on a longer-term migration strategy that will get everyone on the same EMR.

EMR integration isn't going to come quickly or cheaply. But with the right plan, you can eliminate some of the worst headaches.

View Comments: Newest First | Oldest First | Threaded View
Mary E. Shacklett   EMR Integration: A New Frontier of Healthcare Pain Management   10/1/2011 1:35:57 PM
Re: Government Involvement With A Price
Thanks for the comment, cvargas.

It seems that this furthers  "deepens the plot"-- and the quest for EMR interoperability.

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Mary E. Shacklett   EMR Integration: A New Frontier of Healthcare Pain Management   10/1/2011 1:29:04 PM
Re: "World Peace" would be easier...
I tend to agree with you for now, ProgMan.

All it takes is to remember how long it took to break down proprietary communications--with Internet.

It will likely take a similar major and  market-threatening breakthrough in the U.S. with EMR to get companies to help.

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ProgMan   EMR Integration: A New Frontier of Healthcare Pain Management   10/1/2011 8:56:25 AM
Re: "World Peace" would be easier...
"There are several instances in other industries where multiple disparent systems utilize a middleware application/device to map and translate data between systems that otherwise would not be able to communicate otherwise"

Yes, one of those industries is Healthcare.  That is why standards such as HL7 were developed, so multiple disparate systems can communicate with each other.  Healthcare has that down to a science, perhaps better than other industries.  That's not the issue - the issue is a uniform EMR, or standardized patient record.  That is where world peace becomes an easier objective.
cvargas   EMR Integration: A New Frontier of Healthcare Pain Management   10/1/2011 1:29:44 AM
Government Involvement With A Price
One of the big aspects of the newer EMR systems that are being released currently is the aspect of the government involvement that they are requesting new datasets to be captured that previously were not required.  This involvement is commonly referred to as "Meaningful Use".  While the data actually seems to be somewhat minimal that is required, the data actually requires several EMR systems to be updated and/or replaced.  Not only does this add to the pain that many EMR systems face towards API development or even standardization, but the government involvement/requirement is also backed by financial incentives to those organizations that implement the Meaningful Use requirements into their daily practices and organizations.
cvargas   EMR Integration: A New Frontier of Healthcare Pain Management   10/1/2011 12:58:16 AM
Re: "World Peace" would be easier...
While "World Peace" may be easier, it doesn't necessarily mean that the objective of making EMR systems integrate or even communicate with other EMR systems un-obtainable.  There are several instances in other industries where multiple disparent systems utilize a middleware application/device to map and translate data between systems that otherwise would not be able to communicate otherwise.
white.space   EMR Integration: A New Frontier of Healthcare Pain Management   9/30/2011 10:53:08 PM
Re: "World Peace" would be easier...
@ProgMan: I am inclined to agree with you on this one, sitting right here, right now. In theory, I probably would disagree, but there is a lot of difference between theory and practise, especially given the current economic imperatives we have to deal. 

For common standards and practices, we need a better if not different healthcare system first. Maybe in the next couple of decades, patients will start demanding a single consolidated service, somewhere in the cloud, with access and security issues completely worked out. 
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Hospice_Houngbo   EMR Integration: A New Frontier of Healthcare Pain Management   9/30/2011 4:22:50 PM
Re: "World Peace" would be easier...
Instead of thinking about a common standard, we should rather think about how to integrate the different existing formats and move forward. We have learnt to live with different database formats and technologies to chose from. We can also do that with the different UMR systems (or formats).
ProgMan   EMR Integration: A New Frontier of Healthcare Pain Management   9/30/2011 3:43:33 PM
"World Peace" would be easier...
than to think that one day we will have a unified Electronic Medical Record in the US.  Does the government stepping in help?  I don't know.  If we switched to socialized medicine tomorrow, with the government as the only payer in the industry, yeah maybe it would happen.  But with so many large companies in the game, who have little to gain by a standardized EMR, it will succeed in the US as surely as the metric system did.

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