Crisis of Fragmented EHRs

The current scenario of EHR (Electronic Health Records) adoption worldwide reveals a crisis of fragmentation that requires immediate and urgent consideration. Let me share the state of EHRs today and throw some light on what could be done to make it better.

As I see the situation today, the objective of the HITECH Act, part of the American Recovery and Reinvestment Act of 2009, was to accelerate the adoption and promote the “meaningful use” of EHR systems. This was done in the hopes that the efficiency, patient engagement, quality, and efficiency of healthcare delivery could improve and modernize the use of technology by the healthcare industry.

Reasons for Fragmentation of EHRs:

Let me put forth some reasons I deem valid about EHR fragmentation. In pursuit of the deadline of Jan 1, 2014, which the HITECH Act had imposed on medical providers to demonstrate meaningful use or incur a heavy federal penalty, EHR systems were brought to the market in relative haste. Eventually, the situation has become more complex by enhancing the clinical limitations of EHRs.

The State of EHRs Today?

Initially, as we all know, the EHR was a well-organized repository of clinical notes and test reports. This saved immense valuable time for doctors and other healthcare professionals. However, there is now an excess of different EHR systems on the excuse that there is no suitable EHR for every specialty or medical practice. Due to commercialization in this field and the rise of proprietary software, there is a lack of interoperability, which has given way to fragmentation in EHR.??

The Impact of EHRs Fragmentation on Medical Practices

Medical practices face the brunt of the consequences of EHR fragmentation. These have exacerbated the industry’s information-related problems to an unimaginable extent. The issues that arise from these problems range from small illnesses and hospitalizations to long-term sickness and even death. These result in financial costs that run into hundreds of billions of dollars. I want to point out some of these problems below:

Duplicity in Services:??Due to the difficulty in accessing the latest results or the results of the previous tests or procedures of a patient counter, there have been many instances of duplicity in healthcare services, estimated to be at least $200 billion a year.

• Billing:?Because patient, provider, and payer information is fragmented, billing-related services cost healthcare providers and payers about $500 billion a year.
• Fraud:?Healthcare fraud costs $68 billion a year for healthcare services. This can be mitigated using artificial intelligence and algorithms that deal with fraudulent activity in near real-time.
• Medical-Legal Issues:?Due to malpractice claims related to misdiagnoses and other issues, the processing costs surrounding medical liability come to around $10 billion annually. 10% are related to inappropriate medication problems.

The Consequences of EHRs Fragmentation

EHR fragmentation has had several consequences on the healthcare industry. Some EHRs had very complex user interfaces, while others had poor integration capabilities. Other constraints included limited communication abilities, burdensome manual data entry, and extensive documentation requirements. Nevertheless, several challenges exist due to the fragmentation of medical records.

I believe some of these are as below:

• Interoperability?

Interoperability is still a challenge for EHR systems. Each EHR uses different data standards and formats. The different protocols make it difficult for seamless data integration between the systems. Several initiatives have been proposed to promote the interoperability of EHRs at a federal and state level.

Despite enacting the 21st Century Cures Act of 2016, making EHRs interoperable is far from reality. Also, a recent?ONC Study?said that a fragmented EHR market is further fueling the interoperability divide. It found substantial differences between large-practice physicians and solo practices regarding outside data integration.??

• Display Fragmentation

Yet another issue is display fragmentation due to user interface complexity. Complex navigation systems, distant data locations, and an assortment of screens compound this difficulty. Users have discovered that complex user interfaces can be difficult to navigate. This can lead to several workflow inefficiencies since doctors and other healthcare professionals spend most of their time searching for information or entering data.

This can impact productivity and can contribute to physician burnout. Physicians are skilled in treating patients and spending excessive time on data entry and other administrative affairs could adversely affect patient outcomes.?

• Patient Care

EHR fragmentation can also affect patient care adversely. Data that is unstructured and inadequately liked can cause errors and misinterpretations, thereby leading to potentially life-threatening situations.

Also, since many EHR systems do not provide seamless integration with patient engagement tools, it could limit effective interaction between patients and their healthcare providers. This could affect factors such as remote patient monitoring and patient education.

Mitigating EHR Fragmentation—the Road Ahead

As we are stuck with this problem, it is essential to explore the various possibilities of finding a solution to this issue. The problem of EHR fragmentation can be solved only with collective will and resolution.

At the same time, it is essential to enhance the usability of the EHR systems, which should be made the critical goal in this digital era. There is a pressing need to reduce the critical cognitive workload on the healthcare fraternity and focus on the patient-physician relationship simultaneously.

The solution to mitigate EHR fragmentation is also making EHRs more modular and configurable. Each physician has a different work pattern; hence, care should be taken to design an EHR to fit seamlessly with a particular health flow.

So, physicians should be allowed to customize their health IT environment so that fragmentation can be reduced through various visualization techniques and microanalytic methods.

Probable Ways to Mitigate EHR Fragmentation

• FHIR

FHIR (Fast Healthcare Interoperability Resources) is a key breakthrough in solving interoperability issues. Currently, FHIR is changing the rules of the game. It is an efficient way to exchange data. It is also seen as paving the way for a new era of interoperability in the field of healthcare data exchange.

• Real-time Data Tracking

Recently introduced digital technologies such as real-time data tracking and analysis can help mitigate this crisis. This can be done if these technologies are integrated effectively with the EHR systems. I believe these technologies could provide timely insights and mitigate any crisis.

I also believe that such technologies can address the current fragmentation problem by incorporating advanced digital technology capabilities that can lead to better patient engagement, improved communication, and coordinated care delivery. This can lead to a better approach to tackling fragmentation.

• Cloud-based EHRs

Data sources such as clinical, pharmacy, and lab systems can be easily integrated and accessed by cloud-based EHRS. Users are provided flexible options for storing data on multiple servers.

This makes it possible for users to access this data across different geographical locations. Cloud-based EHRs also offer high-level security features to keep data safe from unauthorized access, hackers, and cyber-attacks.

• Open Application Programming Interfaces (API)

EHR interoperability issues can also be sorted using Application Programming Interfaces (APIs). These allow communication between disparate applications and systems. This allows data and protected health information (PHI) to be communicated and shared between EHRs and health information systems.

• Blockchain

This is a decentralized public digital ledger. It records transactions in a verifiable and permanent way. These blockchains are resistant to data modification, so it is tough to tamper with data. Blockchain for Network Provider Identification (NPID) improves EHR interoperability and enables sharing of medical information by patients with their healthcare providers through a private and secure network.

This technology also includes some unique features, such as creating an audit trail in the instance of malicious actors so that the risk of data loss is minimized.

• Cleaner UI

EHR systems can be better designed with cleaner UI to help physicians and clinical teams navigate screens with relative ease. A device with a cleaner UI will have fewer distractions and make information easier to access. They present a lower learning curve and are easier to navigate.

Conclusion

The current scenario concerning fragmented EHRs is extremely compounded due to the present situation. It is also multifaceted and multi-dimensional. I believe the solution lies in improving EHR design, integrating data technologies, and applying AI technology to enhance the quality of patient care.

I believe that EHRs will need a fundamental restructuring of their technical architecture. Will that day dawn when this crisis of fragmented EHRs will end??

What do you think? Let me know in the comments!