In the fantasy world of shared healthcare data, all hospitals will gradually join HIEs, share data regionally and then nationally, and patient care will substantially improve. Or at least hospitals will be in a better position to avoid errors due to critical missing information.
Sure, that’s already happening in some regions of the country. For examples, check out the list of rock-solid HIEs identified by the National eHealth Coalition, including Rochester RHIO, MedVirginia and Availity, all interesting in their own way.
But at the same time, hospitals continue to merge and sell out to larger health systems, in some cases at an almost manic pace. I don’t have the space to list even a few of the mergers that are dominating business coverage, but I’m sure you know of one in almost every market where you work or have business.
These mergers will frequently bring together different EMRs, or even the same EMR configured differently. Not only that, within each hospital, in all likelihood the EMR will have been integrated with internal departments and systems differently. In other words, even two Epic systems aren’t going to marry up easily.
What’s more, when a well-funded hospital buys one in desperate financial straits, which is often the case, what’s the odds the smaller will have a costly Epic or Cerner or Meditech system in place? Not very high, I reckon. So the systems integration problem is even worse. Now, doubtless a large, well-funded system will ultimately put their system of choice in place eventually, but that won’t happen overnight.
So, as merger activity proceeds apace, it’s creating islands of discord and disconnected data. And my best guess is that those hospitals won’t be HIE-ing anytime soon, though I may be off base here.
I do have some hope that the Direct Project will be able to work around some of these obstacles. Though it’s still at the pilot stage, and participants are sharing only a small subset of clinical data, it does seem promising. I’m particularly intrigued by the notion of a HISP (Health Information Service Provider) which helps to push information from one provider to another.
Let’s hope that models like the Direct Project continue to emerge. Otherwise, the Tower of Babel we’ve got is likely to keep babbling.