Health Information Exchange Featured Article

July 26, 2012

EHR Systems Have Long Way to Go Before Patient-Record-Sharing is 'Seamless'

The goal is superb. That is, to let healthcare providers across states have seamless electronic access to patient information for better treatment and outcomes. Then reward doctors who set up the digital records to do it. Fine so far. But what if one doctor’s system doesn’t connect with another's, or a hospital’s? Now you’ve got the picture of just what’s happening in healthcare today.

“Today, each hospital, doctor’s office and physician practice selects health information technologies (HIT) to solve the challenges they see, at a price point they can afford,” writes Keith Figlioli, the senior vice president of healthcare informatics for the Premier healthcare alliance, a national performance improvement alliance of more than 2,600 U.S. hospitals and 84,000 other healthcare sites, at

The result?  Universal dissatisfaction, according to Figlioli. “I’ve never met a provider who said their systems were perfect, interoperable conduits of information across healthcare settings, and I’ve definitely not heard they deliver a strong ROI,” he adds.

Figlioli feels clinicians are unhappy because HIT “operates as a collection of incompatible components stitched together across platforms,” and there are inherent limitations in electronic health records (EHRs). He says, while there’s been a lot of talk about buying and building EHRs, no one gave much thought to how they were all going to work together.

“How useful would e-mail be if it only allowed you to send messages within your company? Or a phone that only allowed calls to those in your home? Yet that’s exactly the kind of siloed system we’ve put in place in our zeal to capture EHR money,” Figlioli reports.

Now here’s where Target comes in. Yes, Target, the giant retailer known for discount designer dresses, Spiderman pajamas and flat screen TVs.

Target has a central system where all data is analyzed and pushed back out to support day-to-day operations, mining purchasing data, tying it to specific individuals and using algorithms to predict future outcomes, according to Figlioli, who notes they are so good at this that Target “can predict which shoppers are pregnant, and customize circulars to feature items specific to that new mom, including diapers, hand sanitizers, lotions, etc.”

Now, what if healthcare operations were run this way? EHRs alone can’t do that, Figlioli asserts, but “built the right way, HIT could consist of data warehouses that catalog the evidence, and applications that provide relevant content on demand to support a range of clinical decisions, engage providers through their choices, make smart predictions and access others’ work automatically without tons of custom programming,” he writes.

Forget about predicting what type of disposable diapers a pregnant woman would buy. Think what a healthcare system we’d have if HIT were able to predict future health events and enable doctors to make better, more customized decisions before a patient arrived complaining of a problem.

Robert Rowley, MD, believes we’re on the brink of EHR consolidation, which would certainly help, with larger companies gobbling up smaller ones, and all seeking market niche rather than the technology itself. Companies that don’t have a large enough “market footprint” will, indeed, crash and burn, but that’s the way the world works.

If EHRs are really going to take off and mean something, “We’re going to have to quickly implement two very anti-capitalistic initiatives: standardization and consolidation,” writes Roheet Kakaday at medpagetoday’s

Edited by Brooke Neuman