Evolving One Step at a Time

Health care is constantly evolving and new technologies and best practice guidelines are being discovered every day. One of the major issues that is preventing healthcare from reaching its full potential is a lack of interoperability. Interoperability is defined as the ability of two or more systems, such as electronic health records, to pass information between them and use the exchanged information (Sewell, 2016). Currently, heath care is wasting about 36 billion dollars because of lack of widespread interoperability. (West Health Institute, 2013). At the facility I currently work at, there is a small amount of interoperability. Within our institution, all lab tests or diagnostic tests are placed within our system and stay with the patient through multiple admissions to our facility. The blood glucose machines are also interoperable with our system. After you take a patient’s blood sugar, you can place the glucometer in a port and it will sync up with the EHR and show up in the patient’s chart. Blood pressure and other vital signs how ever do not have that same functionality and must be manually entered. This is another addition to the waste of time that is in our health care system because of redundancy.

            The main time that lack of interoperability creates a delay in care because of time spent building a patients EHR from scratch is when we get direct admits. Direct admits usally come from a doctor’s office visit in which their doctor was concerned about something and sent them to the hospital, telling them to bypass the ER because they need to be admitted or if they are being transferred from another facility. In both of these cases, the patient comes in with no orders or any record in the system and everything must be added in including: medication history, allergies, and the entire admission database. I had a particular admit from another hospital in Georgia and we got printed lab values and her diagnostic testing on a CD but none of that information was in our system. The CD had to be taken down to radiology for it to be put into our system. There was no way to get the labs into her EHR because there is no interoperability between the two systems. Our system is barely interoperable within various departments let alone transmitting data from another state. In order to see the values, one must look in the patient’s paper chart which in this age of technology is unacceptable in my opinion.

            Because of this, the physicians were ordering the same tests all over again in order to have something on the chart to go by. The cost resulting from this type of redundant testing is about 8 billion dollars a year (West Health Institute, 2013). This is one of many different ways that we are wasting money because of lack of interoperability. The you tube video below outlines this problem as well as provides some things that can be done to improve our current situation and promote interoperability.

            In order to achieve this health care information Nirvana of sorts, there are a variety principles that must be established. The US Department of Health and Human Services is taking measures and coming up with ways in which to start building towards interoperability in health care (Connecting Health, 2014). The developed a 10-year plan that will enable a more standardized way to collect data and more patient centered outcomes. The have come up with 5 concepts that will help with developing a nationwide interoperable health system: core technical standards and functions, certification to adopt the new services, privacy protections for the information, regulatory environment, and getting rules of engagement and governance of the health information exchange (Connecting Health, 2014).

            The first thing that must be created is a standard for terminology used in the electronic health records that is universal and can be understood across various health systems (Connecting Health, 2014). Once that is accomplished then health IT application must also be standardized as well. In order for different applications to be interoperable, the various applications must be governed by the same set of standards they can be easily interoperable. Another big thing that must be taken into consideration is maintaining patient privacy (Connecting Health, 2014). With personal health information having being moved around between different databases, there needs to be a high level of security within the databases and on the transfer from database to database. This is very sensitive information and it needs to be handled delicately and not just thrown around with no security measures in place. Financially, information exchange has to become a priority no matter how much it may cost. Currently there are some systems that have the underlying ability to be interoperable but because of the cost associated to take that final step, there are no moves made to get these platforms talking to each other. Funding needs to be shifted in order to create incentives for making systems interoperable (Connecting Health, 2014).

            Once all of these things are aligned, there will be improvements in patient outcomes we will not be wasting billions of dollars on redundancy. Redundancy of tests and documentation is a serious issue in health care. I spend a lot of time documenting at work and trying to figure out patient information that cannot be found anywhere in the chart. When a patient comes from another facility, all of their medical information should come with them. Interoperability would save time for the new health care team as this would allow them to use the information they have to start to come up with a game plan sooner.

            Not only will interoperability save time for health care providers but also improve patient outcomes. Things such as missed diagnoses and medical errors could possibly be avoided if there was more interoperability between medical devices. Things such as EKG rhythm strips are not included in the MAR. That allow for human error in possibly losing the strip and having no record of an abnormal rhythm possibly (West Health Institute, 2013). Medical errors in IV drips or PCA pump settings could be avoided if those machines were interoperable with the chart. As nurses it can be easy to put the wrong settings into a pump and not even notice. The pump is not going to tell you whether or not you put in the right rates for that patient. If we have interoperability between those devices and the EHR then there would be an extra level of protection against severe medical errors in this area.

            Overall, interoperability would be a complete game changer for health care. It would save billions of dollars as well as save a great amount of time. We need to embrace this and do whatever we can to help the process. If we all work together and embrace the change that is to come, we can maybe have one less obstacle to providing the high quality patient care we got into this profession to do.

References

Connecting health and care for the nation: A 10-Year vision to achieve an interoperable health IT infrastructure. (2014). Retrieved from https://www.healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf

Sewell, J. (2016). Informatics and Nursing: Opportunities and Challenges (5th ed.) Philadelphia,
PA: Wolters Kluwer

West Health Institute. (2013). The Value of Medical Device Interoperability: Improving patient care with more than $30 billion in annual health care savings. Retrieved 2017, from http://www.westhealth.org/wp-content/uploads/2015/02/The-Value-of-Medical-Device-Interoperability.pdf 

Responses:
Raenan Arnold: March 5, 2017at 9:39am
Marilyene Faustin: March 5, 2017 at 10:17am