Healthcare IT Interoperability and EMR Interoperability Explained

This video provides an in-depth exploration of Electronic Medical Record (EMR) and Electronic Health Record (EHR) interoperability, focusing on the challenges and realities of sharing healthcare data between different hospital systems and doctor practices in the United States. Dr. Eric Bricker begins by establishing the context that the vast majority of health information is now stored electronically, moving away from traditional paper charts. He highlights the historical problem of data siloing, where individual healthcare providers had their own computer systems that did not communicate, leading to fragmented patient information.

The presentation then delves into the widespread consensus among various stakeholders—patients, federal and state governments, insurance companies, employers, and even the American Hospital Association (AHA)—that health information should be shared. The stated benefits of interoperability are compelling: increased patient safety, improved care quality, enhanced ability to track public health issues like pandemics, and decreased healthcare costs. Despite this universal agreement on the desirability of data sharing, Dr. Bricker transitions to reveal the stark reality of its implementation across major U.S. cities, citing data from the federal government.

The video presents specific statistics on the percentage of hospitals sharing patient data in various metropolitan areas, showcasing a wide disparity: Cleveland leads at 78%, followed by Miami (77%) and Dallas (60%), while Boston stands at 50%, and Philadelphia lags significantly at only 35%. Dr. Bricker expresses skepticism and disappointment at these low figures, questioning why such fundamental data sharing remains elusive in an advanced technological era. He then introduces a critical insight: the barriers to interoperability are not solely technological. He shares a compelling true story about a large multi-specialty physician practice (over 500 doctors) that deliberately stopped sharing CT images with a local hospital, despite having previously seamless, cost-free interoperability. Instead, they began charging patients to burn images onto CDs, forcing patients to physically transport them. This policy change, he notes, correlated with the practice being acquired by a private equity firm, suggesting that financial incentives and strategic patient retention (using data as leverage) can override patient-centered care and efficient data sharing.

Key Takeaways:

• Definition of EMR/EHR Interoperability: Interoperability refers to the ability of different healthcare systems and practices to seamlessly share electronic patient data, including disease history, physical exam findings, lab results, and imaging scans (CT, MRI, X-rays).
• Universal Desire for Data Sharing: There is broad consensus across patients, federal and state governments, insurance companies, employers, and even the American Hospital Association (AHA) that health information should be shared for better healthcare coordination.
• Significant Benefits of Interoperability: Sharing health data is crucial for increasing patient safety, improving care quality, facilitating the tracking and management of public health crises like pandemics, and ultimately decreasing overall healthcare costs.
• Low Rates of Actual Interoperability: Despite the recognized benefits and technological capabilities, the actual rates of health information sharing among hospitals in major U.S. cities remain surprisingly low, with figures ranging from a high of 78% in Cleveland to a mere 35% in Philadelphia.
• Beyond Technological Barriers: The primary obstacles to interoperability are often not technological limitations but rather organizational unwillingness, competitive strategies, and financial incentives that prioritize self-interest over patient care.
• Data as a Competitive Lever: Healthcare providers, particularly large physician practices and hospital systems, may intentionally restrict data sharing to increase "patient stickiness," making it harder for patients to seek care elsewhere and reducing competition based on price and quality.
• Impact of Private Equity Ownership: A real-world case study illustrates how a multi-specialty practice, after being acquired by a private equity firm, ceased providing direct access to patient imaging data to an affiliated hospital, instead reverting to cumbersome, patient-burdened methods like burning CDs.
• Discrepancy Between Stated and Actual Priorities: Organizations often claim to be "patient-centered" in their marketing, but their actions, such as deliberately hindering data sharing, reveal their true priorities, which may be profit or market control.
• Inefficiency of Non-Interoperable Data Transfer: The practice of burning medical images onto CDs for patient transport is highlighted as an outdated, clunky, and inefficient process that significantly impedes timely and effective patient care, especially in critical situations like cancer diagnosis.
• Implications for Patient Choice and Quality of Care: The lack of interoperability can restrict patients' access to world-expert physicians or alternative care settings, as their data is held captive within specific health systems, potentially compromising optimal treatment outcomes.

Key Concepts:

• EMR (Electronic Medical Record): A digital version of a patient's chart from a single practice or hospital.
• EHR (Electronic Health Record): A more comprehensive digital record of a patient's health information that is shareable across different healthcare settings.
• Interoperability: The ability of different information systems, devices, and applications to access, exchange, integrate, and cooperatively use data in a coordinated manner.
• Data Siloing: The isolation of data within individual systems or departments, preventing easy access and sharing across an organization or between different organizations.

Examples/Case Studies:

• U.S. Government Interoperability Survey: Data from the federal government (healthit.gov) on the percentage of hospitals sharing patient data in major U.S. cities, including Cleveland (78%), Miami (77%), Dallas (60%), New York City (59%), Chicago (58%), Boston (50%), Washington D.C. (44%), Los Angeles (41%), and Philadelphia (35%).
• Multi-Specialty Physician Practice Case Study: A 500+ doctor multi-specialty practice in a major U.S. city that ceased providing direct electronic access to CT images for a local hospital, instead requiring patients to pay for and transport images on CDs, a policy change that correlated with new private equity ownership.