Doctors have complained about EHRs’ inability to transmit and receive patient data for nearly as long as the technology itself has existed, and that shortcoming remains one of their chief criticisms.
“None of the computers talk to each other,” says James Dunn, MD, an internist in a Muncie, Indiana, group practice and survey participant. “They’ve got so many different vendors out there and none of them have any kind of interface with each other.”
Dunn, whose practice uses EHRs from InSync, says that while he is usually able to access patient information electronically at his local hospital system, “I have to go through about eight different steps to get there. It’s very frustrating.”
Adding to his frustration, he says, is that he tries to use Direct Messaging—a standardized protocol for exchanging clinical messages and attachments—and even has accounts both through InSync and the hospital system. But hardly any other providers communicate with him through the service. His own attempts at using the service to exchange information with other providers have met with only limited success, he adds.
As an employee of a large hospital system, Friedberg communicates mostly with providers who are also using Epic. Even so, he says, he faces challenges when exchanging patient data. “Not everything ports over because not everybody has the exact same configuration,” he says. “So you might have a lot of custom stuff that doesn’t come over, or doesn’t fill into the right places in my EHR.”
When one of Friedberg’s patients gets treatment from a physician outside of his system, even one that also uses Epic, “I get a notification that they’ve received care but I have to go through a bit of a rigmarole to actually see what happened,” he says.
Information from providers not on Epic—if it comes at all—is faxed, and then has to be scanned into his system. “It ends up in some part of the record where it can’t do any successful system support, with rare exceptions,” Friedberg says. “And the costs are prohibitive for actually getting the data elements into the system in a coded way.”
Poplin attributes the difficulty achieving interoperability to its low priority under the original Meaningful Use requirements. “All you had to do was a test with one other system, and it didn’t even have to be successful,” she points out. “Interoperability should be the first requirement, not the last.”
Perhaps not surprisingly, Poplin’s experience as a physician in the military has left her pessimistic about the feasibility of interoperability. “I watched the defense department and [Department of Veterans Affairs] struggle for 10 years to make their systems interoperable, and after all the money and time, they gave up,” she says. It shows how difficult it is once the systems are in place.”