“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.