FW: Why legacy EMR systems will struggle henceforth with meaningful use/interoperability

[Edmund Billings]

------ Forwarded Message
From: "Dr. Tom Schwieterman" <schwie...@hometowncable.net>
Reply-To: <cgc-m...@googlegroups.com>
Date: Tue, 27 Oct 2009 13:08:51 -0700
To: Clinical Groupware Collaborative Members <cgc-m...@googlegroups.com>
Conversation: Why legacy EMR systems will struggle henceforth with meaningful  use/interoperability
Subject: Why legacy EMR systems will struggle henceforth with meaningful  use/interoperability



All,

I enjoyed the following article at HISTALK.com as it illustrates the
inadequacy found within the legacy EMR systems architecture- simply
stated, they cannot function well in a broader interoperability
climate. Speaks to the need for a new open standards/open architecture
clinical groupware scenario.

Tom Schwieterman MD

++++++

See teh article at HISTALK.COM

EMRs and Interoperability: HIT's Oxymoron?
By Lynn Vogel, PhD, FHIMSS, FCHIME

ox·y·mo·ron; \äk-sē-'mor-än\, noun, a combination of contradictory or
incongruous words (as cruel kindness); broadly : something (as a
concept) that is made up of contradictory or incongruous elements[1]

 How odd, you say, to propose as an oxymoron two terms that
politicians, IT luminaries, healthcare experts, vendor product
brochures, and academic journals typically assume simply and
reasonably can and must go together. But do they really go together,
or are we just trying to make them fit when maybe they don't?

Consider the fact that every EMR product on the market today started
with a single purpose: to automate the workflow of clinicians within a
specific organizational setting, and in the process, seek to make it
more efficient and more effective. Among other features, EMRs focus on
making data from previous encounters or activities easier to access,
assuring that orders for tests and x-rays have the right information,
or that the next shift knows what went on previously. In general, in
spite of visible successes and failures for all manner of products,
EMR products do a pretty good job of automating a complex workflow --
of automating intra-organizational clinical processes.

But interoperability, in the sense in which the term is used in
today's discussions about Health Information Exchanges (HIEs), is not
about intra-organizational workflow, but about inter-organizational
work flow. Recognizing that patients often receive care in a variety
of organizational settings -- hospitals, multiple physician offices,
rehabilitation facilities, pharmacies, etc. -- the challenge is to
extend the internal workflow beyond the boundaries of individual
organizations so that data is available across a continuum of care.
Interoperability, then, is not so much about what happens within an
organization, but about what happens across organizations.

A major assertion here is that the architectural requirements for
automating intra-organizational clinical workflows are very different
from the architectural requirements for facilitating inter-
organizational interoperability. An intra-organizational architecture
focuses on facilitating real-time communications among providers,
optimizing the process of collecting data at the point of care, and
ensuring that clinical tasks are carried out in an appropriate
sequence.

An inter-organizational architecture needs to be designed to minimize
the duplicate collection of data in different care settings, to
facilitate quick searches of relevant data from a variety of
organizational sources, and to rank data in terms of relevance to a
particular clinical question.

If these assumptions are true, then one has to wonder whether we can
ever achieve true inter-organizational operability using an
architecture that has focused for more than a decade on optimizing
intra-organizational processes.

An appropriate analogy might be taking a bunch of cars, which were
designed to accommodate small numbers of people, and somehow string
them together to make a bus in order to accommodate a large number of
people with the same goal of moving them from one point to another.
Yes, you could make a bus out of cars -- no doubt with a lot of effort
-- but why would you? Requirements for tires, suspension, seats,
luggage storage, and even bathrooms are very different for buses than
for cars and require a different architecture if you want to build a
bus that works. But isn't that what we are trying to do with current
proposals for using EMR architectures to build HIEs?

Maybe it's time to rethink this approach. Interestingly we don't have
to look very far to find a set of experiences that would make more
sense for an interoperability architecture than trying to extend our
current EMRs. It's  the Internet. With millions of different data
repositories around the world, an architecture that seems to work most
of the time, and increasingly sophisticated search engines for
locating data, it would seem that we should be looking more closely at
the services-oriented architecture of this ubiquitous example of
interoperability rather than trying to string EMRs together and
replicate their architectures in an attempt to achieve objectives
which were never in their initial designs.

So that's why EMRs and Interoperability may be HIT's oxymoron: the
architectures may simply be too contradictory and too incongruous to
fit together no matter how hard we try. If so, this would add a
significant constraint to HIEs that are already being challenged by
the sustainability of their business model. Bus manufacturers learned
long ago that simply making cars bigger using the same underlying
components wouldn't result in a workable bus. Perhaps there is a
lesson here for how we should be thinking about interoperability.

[1] Adapted from http://www.merriam-webster.com/dictionary/oxymoron,
accessed on 9/19/2009.

Lynn Vogel, PhD, FHIMSS, FCHIME is vice president and chief
information officer and associate professor of bioinformatics and
computational biology at The University of Texas M.D. Anderson Cancer
Center in Houston, TX.


------ End of Forwarded Message

[Blaine Warkentine]

Agree!!