Zen’s Last-Mile EHR Interoperability Resource Guide
It is important to understand Last-Mile EHR Interoperability. Healthcare data exchange and information sharing capabilities have increased significantly over the last decade. The migration from paper-based claims and reimbursements to fully electronic revenue cycles for medical practices and hospitals has been established. We experienced the largest transformation in the industry from exclusively paper-based medical records to electronic health records (EHR) thanks to incentive and economic stimulus programs.
On the heels of these advancements is the reality that data sharing and data fluidity between healthcare systems have yet to be fully deployed. This guide helps explain the current health information exchange gaps and provides insights into best practices for closing those gaps.
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Defining “Last-Mile EHR Interoperability”
To define “Last Mile EHR Interoperability,” it is important to understand the concepts behind each word. Let’s start at the end of the phrase and work backward.
Interoperability: the inherent ability for healthcare technologies to request, consume, query, or send electronic data between different computer systems. The data is not only exchanged, but also consumed and rendered to users of the system to make informed decisions about healthcare treatment and payment.
Electronic Health Record (EHR): the application used by clinical staff to electronically record clinical encounters with patients. These systems store historic information about patients medical history, medications prescribed, and supporting treatment documentation. EHRs provide tools not only for documenting care but also for communicating treatment orders, laboratory and imaging studies, medications, and even referrals to other providers.
Last-Mile: a metaphor describing the distance between the current state and the ideal state of a process; an especially applicable description for an initiative that has made tremendous progress, but still has a few last milestones to achieve the ideal future state.
Now that we have deconstructed individual concepts, let’s reconstruct them to define the phrase in total.
Last-Mile EHR Interoperability describes an important gap in the ability for healthcare providers to use an EHR and other health information systems to easily access clinical data across disparate care settings in order to make data-driven patient care decisions.
Common Last Mile EHR Interoperability Gaps
There are dozens of examples of interoperability gaps in healthcare data exchange. In this resource guide, we highlight three common scenarios.
Patient Safety & Care Quality Gaps
Zen Healthcare IT partners with EHR vendors, medical practices, and health information exchange (HIE) organizations to establish interoperability to close this important patient safety and healthcare quality gap. How can we help you?
#1 – Last Mile EHR Gaps Scenario for Physician Offices
Suppose a patient shows up at her doctor’s office for a regularly scheduled appointment. This time she has new complaints of a recurring headache and dizziness. The clinical staff starts down a course of treatment based on the information the patient reports and what they find upon physical examination. They find she has elevated blood pressure and plan to send her home with an adjustment to her blood pressure medication.
On the way out the door, the clinical staff noticed she was walking with a slight limp favoring her right leg. Upon asking why she was limping, the patient tells the staff she was in a car wreck last week, went to the urgent care, and totally forgot to tell them about the accident during the visit because she didn’t have any broken bones. Come to find out, she had a pretty bad concussion as a result of the wreck.
Even though the doctor’s office and the Urgent Care Center are both using popular electronic health record systems, the staff at the doctor’s office didn’t receive any information about the patient’s encounter at the urgent care facility.
This story, though simple, represents true technology and infrastructure gaps that exist today despite the active use of electronic health records. The good news is that the interoperability gaps represented in this story can be closed with the right right systems and process in place.
#2 – Last Mile EHR Gaps Scenario for Health Information Exchange (HIE) Organizations
A Health Information Exchange (HIE) organization serves an important role in enabling clinical data exchange between care facilities within a community through technology services.
Suppose a local Health Information Exchange (HIE) organization has successfully established bi-directional data exchange between all of the major hospitals and surgery centers in the region. Several of the physician practices in the metro area are owned or closely affiliated with those facilities. As a result, they too have connectivity to the HIE.
Based on these advances, healthcare providers connected in these systems are able to see patient encounters and events recorded in the hospital systems. They are also able to see surgical events and consults recorded in the ambulatory surgery centers, something that was not possible in recent history.
Unfortunately, like most regional healthcare events, a majority of the patient care encounters throughout the region are done in medical practices and other facilities that are not a part of the major hospital networks and not connected into the region HIE. Therefore, providers are only getting a fraction of the real clinical history for a patient across the care settings.
Health Information Exchange organizations must find ways to technically and sustainably create interoperability data flows with these individual, independent ambulatory care centers. Given the variance in the type and brand of electronic health records (EHR) used and the variable levels of technical competency at the physician offices, connecting these medical practices to the HIE network is challenging. The HIE often doesn’t have the staff resources nor the business model to support individual connectivity projects necessary to make these connections. As a result, the community is faced with a large gap in the continuity of care.
Integration Resources for HIEs
Zen Healthcare IT helps HIEs connect and manage integrations with medical practices and other healthcare facilities. Ask us about our technology and services to help with data acquisition to close the ambulatory care gap. Let’s start simplifying your interoperability today!
EHR Vendors Avoid Customer Attrition
Zen Healthcare IT helps EHR vendors create a sustainable infrastructure for interoperability. Ask our team about the Gemini Integration as a Service platform and associated managed services to make community-wide medical practice interoperability a reality.
#3 – Last Mile EHR Gaps Scenario for Healthcare Technology and EHR Vendors
There are hundreds of Electronic Health Record (EHR) vendors nationally and thousands represented globally. Each vendor faces the challenge of making their software interoperable with all the different health information endpoints (hospitals, health information exchanges, health plans, patient portals, disease registries, other physician offices, etc.) requested by their clients.
Suppose an EHR vendor has a concentration of customers in a local area. The local area includes an active HIE, two hospital systems, and an active specialty network. There is an area-wide focus to make health information available across the care settings and the EHR vendor’s clients are constantly asking for help to connect to the community.
Despite a commitment to serve the clients in this community, the EHR vendor is finding it challenging to apply the right people and technology resources needed for this group of customers. After considerable due diligence on the connectivity needs, the vendor concludes that the development to support data acquisition and the ongoing connectivity management required to create a sustainable interoperability connection just isn’t possible in the near-term.
This creates a last mile connectivity gap for the vendor. They have the intention and dedication to serve customers, but just do not have the resources available nor the time needed to make the connectivity possible. This leaves a segment of the medical practices in this community disconnected from the health information exchange network putting patient safety and quality of care at risk.
Top Five Benefits to Achieving Last Mile EHR Interoperability
Organizations who solve last-mile EHR interoperability challenges experience many benefits. In our review with clients and other healthcare leaders, here are the top five benefits organizations can expect.
1. Informs value-based care programs
2. Enables bi-directional data exchange
3. Supports CMS quality measurement & participation
4. Fuels chronic care management
5. Drives opioid and Prescription Drug Monitoring Programs (PDMP)
Top Five Challenges to Achieving Last-Mile EHR Interoperability
Though the following challenges can be overcome, the list represents the common obstacles encountered by healthcare organizations.
1. Cost and resources required to establish connectivity
2. Challenging to o
3. A large number of possible ways of connecting (proliferation of healthcare standards)
4. Data exchange business rule complexity
5. Legal overhead and security risks
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