Risk of Interoperability is Worse Data

I’m a huge fan of healthcare interoperability. I think it needed to happen yesterday and that we could solve a number of our cost issues with healthcare data interoperability and we could save lives. Both of these are very worthy goals.

While I’m a huge fan of healthcare data interoperability, we also have to be careful that we do it right. While there are huge potential benefits of exchanging healthcare data, there are also huge risks involved in it as well. We have to address those risks so that interoperability doesn’t get a black eye because it was poorly implemented.

A great example of the potential risk of interoperability is making sure that we process and connect the data properly. Some might argue that this isn’t that big of an issue. Healthcare organizations have been doing this forever. They get a medical record faxed to their office and the HIM team lines up that medical record with the proper patient. I’m sure the medical records folks could tell us all sorts of stories about why matching a faxed medical record to a patient is a challenge and fraught with its own errors. However, for this discussion, let’s assume that the medical records folks are able to match the record to the patient. In reality, they’re certainly not perfect, but they do a really amazing job given the challenge.

Now let’s think about the process of matching records in an electronic world. Sure, we still have to align the incoming record with the right patient. That process is very similar to the faxed paper record world. For the most part, someone can take the record and attach it to the right patient like they did before. However, some EHR software are working to at least partially automate the process of attaching the records. In most cases this still involves some review and approval by a human and so it’s still very similar. At least it is similar until the human starts relying on the automated matching so much that they get lazy and don’t verify that it’s connecting the record to the correct patient. That’s the first challenge.

The other challenge in the electronic world is that EHR software is starting to import more than just a file attached to a patient record. With standards like CCDA, the EHR is going to import specific data elements into the patient record. There are plenty of ways these imported data elements could be screwed up. For example, what if it was a rule out diagnosis and it got imported as the actual diagnosis? What if the nurse providing care gets imported as a doctor? Considering the way these “standards” have been implemented, it’s not hard to see how an electronic exchange of health information runs the risk of bad health data in your system.

Some of you may remember my previous post highlighting how EMR perpetuates misinformation. If we import bad data into the EMR, the EMR will continue to perpetuate that misinformation for a long time. Now think about that in the context of a interoperable world. Not only will the bad data be perpetuated in one EMR system, but could be perpetuated across the healthcare system.

Posts like this remind me why we need to have the patient involved in their record. The best way to correct misinformation in your record is for the patient to be involved in their record. Although, they also need a way to update any misinformation as well.

I look forward to the day of healthcare data interoperability, but it definitely doesn’t come without its own risks.

About the author

John Lynn

John Lynn

John Lynn is the Founder of HealthcareScene.com, 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, EXPO.health, 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.


  • As you rightfully said there are risks either way – doing it the conventional fax/mail way or the Exchange/Direct/Connect automated way.

    Based on what is happening in everyday life of HIT, we have already, to a great extent, have been able to match the results from Labs and Imaging Centers and this has been in effect over the last 3+ years. We, as in EHR/HIT Solution providers have also been able to match the ADT data from the hospitals into the Ambulatory EHR without any issues. So I don’t think that matching is an issue any longer and the worry about the patient records being misplaced is something that needs any concern at this point.

    Yes; the CCDA and transfer might have issues and unless and until its used, no one will ever come to know about the issues or fixes for the same. Its the same thing as why interoperability was not mandated from day 1; because there was no data to interoperate and unless and until a critical mass of physicians start using the EHR to capture the data.

    I am sure over time this will also be resolved like all the other challenges.

  • Don’t forget about clutter. As a specialist, I don’t need MY chart cluttered by primary care dx (that are important to THEN, but not me), such as plantar fasciitis, toe nail fungus, etc. I don’t even want those dx in my charts, bec they just distract from seeing the more systemic problems that I need to focus on.

    Also, I can’t tell you how often a patient leaves an ER with an incorrect diagnosis of ULCER. I don’t want that in the chart, its erroneous.

    And yes, while it MAY be helpful to have a pt see their chart, we certainly don’t need them cluttering it up with things they may think are important (see above), but may not pertain to the specialist they are seeing, nor do we want to allow them to delete information from their chart that is factual (e.g. drug use, h/o hepatatis C, etc).

    In a paperchart world, the job was to get the right information in the chart. NOW the job is to get and KEEP the right info IN, and to get the WRONG INFO OUT (bi-directional now).

    No wonder my back strain and carpal tunnel are getting worse!

  • Good points Anthony and Jacques. The idea of clutter is a really interesting one. I think that’s something that every EHR vendor is going to have to deal with. The winning EHR companies long term will get really good at surfacing the information you need and hiding the information that’s not relevant. Much easier said than done (not to mention automated).

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