The Pains of Healthcare Data Interoperability Described First Hand

I was hit by this comment made by Ciro on a LinkedIn group that I’m apart of (You can find the blog network on LinkedIn if you want to join).

My patients are discharged from hospitals and are seen in different offices. I have no clue what changes have been made when I open the patient’s record in my emr. We have to call to have notes faxed to us all the time. Then we scan the documents into the emr and attach it to the patient record as a tif file. If a patient has a reaction to a medication and is seen at urgent care facility, I will not know about it unless the patient tells me. There is no integrity in my emr data since changes are made all the time. Our hospital recently spent millions on a emr that does not integrate with any outpatient emr. Where is the data exchanger and who deploys it? What button is clicked to make this happen!

My practice is currently changing its emr. We are paying big bucks for partial data migration. All the assurances we had about data portability when we purchased our original emr were exaggerated to make a sale.

Industry should have standards. In construction there are 2×4 ‘s , not 2×3.5 ‘s. Government should not impinge on privacy and free trade but they absolutely have a key role in creating standards that ensure safety and promote growth in industry.

I have 3 takeaways from Ciro’s comments.

1. The Pain of NO Healthcare Data Exchange – I can’t remember ever reading a first hand account that so aptly described the pains a doctor faces in trying to care for a patient and not being able to get the data they need to care for the patient properly. We need more stories like this that describe the pains of getting data exchanged in healthcare. Doctors need to recognize these pains and broadcast it far and wide. Otherwise, we’re not going to see any real significant movement. Patients can join in the chorus as well.

2. Healthcare Data Exchange Is Still Far Away – “Our hospital recently spent millions on a emr that does not integrate with any outpatient emr.” Doesn’t that comment just sting you to the core? If it doesn’t you’re probably the one that collected the million dollar checks from the hospital. I’m not sure what to say about the CIO that purchased a system that wouldn’t integrate with other EHR software.

3. Govenment’s Missed Opportunity – The last paragraph of Ciro’s comments talks about how the US government should have helped create a standard for data exchange. I still believe the EHR incentive money should be spent on establishing this standard and rewarding use of the standard. It’s probably too late now.

Keep the stories of terrible experiences exchanging healthcare data coming. I love to learn from first hand experiences. So, send them over and I’ll be sure to get your stories out and heard. Examples of great electronic healthcare data exchange would be welcome too. Few things motivate and gets things accomplished as much as pain and jealousy.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • One would have thought that standards to ensure interoperability would have been the first thing ONC did. But … you can’t burn as much others people’s money (I mean incentivize the economy) doing things the right way that you can by developing a program to dig random holes in the ground.

  • I’ve been preaching this for more than a decade. However, the solution is anti-hegemonic for the way computer science is taught. A multi-level approach that separates the software information model and uses constraints on that model to define the concepts is,in my opinion, the only way to manage the increasingly complex healthcare information in a semantically coherent fashion. See:

  • Hi John,

    I’ve been running an academic project based on multilevel modeling specifications (MLHIM and openEHR) since 2009 and I can assure you that this is not trivial science. So, I am not sure it can get “translated” inside the tight space of a blog post comment.
    Mr. Cook has been our international collaborator and I am honored to have co-authored with him a paper on multilevel modeling that will be published soon on the IFIP Advances in Information and Communication Technology. Other papers on the openEHR specifications and the ISO 13606 standard are available on PubMed. The documentation on the MLHIM and openEHR websites is very enlightening as well.

  • Doesn’t your hospital’s EMR have a CCR export feature?
    You could get the discharge summary that way.
    The discharging physician can send it to you for free via [free for all USA mds].

    Same goes for the Urgent Care center seeing your patient for an allergic reaction.
    I agree [everyone agrees] that data interoperability needs to be easier, but in the meantime there are workable solutions if you look for them.

  • charles,
    Actually, many hospital systems don’t support the CCR export. Many of them will eventually be able to support one of the 5 CCD standards. I just love that there are 5 versions of a standard. Quite the standard, no?

  • Luciana,
    Don’t you think it’s going to be an issue that you can’t summarize it? How are you going to sell the vision of what’s really possible with the standard so that people want to adopt it if you can’t summarize it?

    Maybe this is just the practical part of me taking over.

  • I agree 100 percent with Tim Cook when he says that
    the only way to deal with complexity in healthcare information is through a semantic approach. To solve
    the problem with interoperability is to add a layer
    of metadata HL7 or any other defined stantdards with
    a semantic application ie the patient file.

  • I believe that HITECH is proof of the non-market ready status of EHR technologies.

    Docs are eager technology adopters. Why not EHR technologies? No lust. They haven’t had that “Oh … My God!” quality to them. Steve Jobs understood the need for that quality to get people to part with their money.

    So, bureaucrats, politicians, academicians, and administrators foisted this upon us anyway, “for our own good,” complete with transient carrots and durable whips.

    What we get is stuff not written for busy clinical work flows, and that interferes with normal human interactions, both pretty important parts of what we do.

    And if we don’t like the product after blowing big bucks on it?

    So sad. Too bad.

    Try changing to another product. How? Patient data is locked to the product. Data migration is expensive and onerous. (Might as well dump it all back to paper.)

    When clinicians are free to change EHR products at will (= competition), product quality will improve and price will drop, establishing a positive feedback loop of adoption. In this way, the market would accomplish what the government cannot.

  • horseshrink,
    Interesting thoughts. I agree with your last couple paragraphs big time. I’ve been thinking about how to start an initiative that would get EHR vendors to “certify” that they can export all their EHR data. I’m just trying to figure out the right way to execute it properly. I’m sure many EHR vendors would kick against it, but that’s alright. It would be a great differentiator for those who do it.

  • Why not metatag all information in the way we do out in the web? Regularly index the data (Google style), analyze it (Wolfram Alpha style), and you have instant access to any information in the medical record, and the ability to do something useful with it. And … you have a set of data standards. No need to export data. Just sit a new product on top of it … a bit like switching browsers.

    Another difficult challenge … data entry (speed or cost.)

  • horseshrink,
    What you describe could be part of the solution. The goal of what I describe would be to help doctors overcome the fear that they’re “locked in” to an EMR, because the switching costs are so high. I want to lower the EHR switching costs so that doctors 1. won’t be afraid to select and implement an EHR and 2. that EHR’s will be held accountable to their users.

  • Agree. The extent to which EHR switching costs (time, $$$) are minimized is an extent to which docs would feel more comfortable with taking the dive.

    Other issues persist, e.g. productivity problems due to slow data entry, notes that all look alike, intrusions upon normal human interaction, and TOC over time.

    Perseverating a bit on standards …

    HTML development occurred before Netscape Navigator or Internet Explorer existed. A common language for data wildly fueled the WWW and related businesses.

    Though there is controversy about who influences those standards, or the rigor with which developers adhere to them, there is enough commonality that I can type an arcane search phrase into a multitude of search engines and be overwhelmed by the results.

    Data standards first. Products second.

    If this is done with EHRs, I think we’ll get a lot farther down the road faster.

  • My insurance company charges extra if a company wants its employees to be able to do data exports from its site (supposedly they follow one of the standards, don’t know which).

    My HealthIT instructor had some tests at one major Long Island hospital (attached to a med school and major university). MRI and other imaging. He then had to go into a hospital from another major hospital system on Long Island. That hospital had no way to get imaging from the first – unless the patient hand carried in the films. They couldn’t even take images on CD or DVD. From family experiences in that hospital, I can say that it’s not always possible to get test results from when the person is in the ER once they’ve been admitted to a room. Frightening.

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