Synchronizing Patient Medical Records Across Institutions

Introduction

With the advancement of information technology into the medical field, the healthcare industry is continuously becoming reliant on the contributions that IT brings, and it has shown exemplary reception of these innovations. One of the most significant contributions of IT in the medical field globally is the electronic health record (EHR), which has been widely received as a solution to various challenges that healthcare providers have faced, including scheduling difficulties, information storage, order management, retrieval of patient information, room allocation, patient admission and discharge, and the coordination of medication rounds (Menachemi & Collum, 2011).

However, the introduction of electronic health records has come with a number of challenges that still need to be resolved before these systems can effectively serve healthcare facilities. The large volumes of data stored through EHR systems are only meaningful and useful if the relevant information can be easily shared across medical institutions when needed, without compromising the integrity or confidentiality of that information. There have been significant challenges among institutions that use electronic medical records systems (EMRS) in terms of the inability to synchronize or interface patient medical information from one institution to another.

Institutions hold large volumes of information that are pertinent to the treatment of patients throughout the United States—particularly those with chronic diseases or conditions requiring specialized treatment where medication history is critically important—yet transferring this information from one institution to another has become a major challenge. There is therefore a need for an alternative system or system adjustment that would not only enable information sharing across institutions, but also make that sharing efficient and timely upon request.

As a project manager, this paper outlines steps to overcome the bureaucratic and structural barriers that exist in the current information-sharing platform and to institute a more efficient system, drawing lessons from the existing system to address the challenges experienced by the current EMRS. The case study first analyzes the current EMRS and identifies its weak points. The effects of these faults are highlighted, systems used in other developed nations are discussed, and an alternative system suitable for the U.S. context is presented. The implementation plan, the necessary personnel, and the accompanying training required to effectively implement the new EMRS within healthcare facilities and relevant institutions are also addressed.

The significance of this intervention extends to solving workflow challenges that institutions face due to the current EMRS, which creates backlogs and inefficiencies that may ultimately compromise patient safety. There is a clear need for a data exchange system that functions effectively not only within individual states, but also for patients who travel across the country and require medical attention away from their home institution.

The Current EMRS Used in Institutions

The system currently used in EHR management is widely regarded as a stumbling block in the process of data exchange between stakeholder groups. From the provider's perspective, the most important feature of an electronic record system is the ability to make information available when and where it is needed. The current electronic system falls short in this regard because health information exchange faces several challenges, some technical and others stemming from the regional nature of the healthcare system and the laws that leave the country with a fragmented healthcare market.

A typical EMRS consists of a central data storage and access point that serves as the hub for users, with stakeholders who rely on the data collected and stored at that central data bank positioned at the periphery. These stakeholders include hospital administration, medical departments, doctors, patients, laboratories, pharmacies, and insurers.

The EMR system that predominates in patient information management was originally designed for billing and insurance data management. Over time, however, the rate of data exchange between departments increased and the systems were developed for clinical use, resulting in the EMR system now used in many hospitals. This system is significantly better than the previous paper-based filing systems and handwritten records that once filled hospital storage rooms. The EMR is versatile, easier to access, enhances communication, improves data accuracy, and can be considered a long-term cost reduction measure for institutions that have adopted it.

The EMR system's data bank stores specific details about each patient, including registration information, problem lists, encounter records, care plans, and related orders. It also stores service instances such as procedures and legal documents, patient schedules, departmental supply and equipment orders, surgical and outpatient procedures, invasive diagnostic studies, bedside procedures, imaging results, physiologic tracings, special studies, practitioner notes, provider observations, identifying information, health history, and physical examination findings covering vital signs, general status, and all major body systems (Carte, 2016). These elements form the core of the information stored in the central EMR data bank.

System Challenges

The Institute of Medicine recognized the centrality of the EMR in 2003 and the transformative role it could play in healthcare. This prompted the agency to outline eight key functions targeting safety, care efficiency, and quality that the EMR needs to support: physician access to information including allergies, lab results, diagnoses, and medications; access to previous and new test results among providers in multi-care situations; computerized provider order entry; prevention of drug interactions through a computerized decision-support system; secure electronic communication among providers and patients; patient access to disease management tools, health records, and health information resources; a computerized administrative process including scheduling; and standards-based electronic data storage and reporting for patient safety and disease surveillance.

Despite these being the intended purposes of the EMRS, they have not been fully realized. The situation has trended toward greater inefficiency, particularly in the face of gradual changes brought about by the implementation of the Affordable Care Act. In order for providers and payers to effectively serve patients under the new healthcare system, greater interaction among stakeholders is required—interaction that can only be facilitated through a more robust and interconnected system built upon the existing infrastructure with significant improvements.

The current system directs all concerned stakeholders to a central repository to retrieve the information they need. This information may not be as comprehensive as a doctor or hospital requires, and there is little recourse available. Personnel must notify the relevant party and wait for the information to be made available on the shared database. There is no mechanism for a doctor to retrieve information directly from the source, or to pass information to a third party, except by inputting it into the common database for that third party to retrieve from the common pool.

This process is time-consuming and inconvenient; in an emergency, the person responsible for making information available may not perceive the same urgency when communicating with a database rather than another human being. This creates a serious interoperability challenge in which interaction is not between two stakeholders directly to expedite patient care, but between an individual and a machine—or worse, when the patient must carry information from one provider to another, undermining the very purpose of EMRS interoperability (Pennic, 2015).

The challenge worsens when these already-inefficient systems are unable to exchange patient information across states because they cannot interface with one another. The current EMRS accommodates technical variations in EHR systems from different vendors, hindering the developments and efficiencies that a coherent, interoperable system could provide.

Conclusion

From each section of the new EMRS, a maintenance and support strategy will be required. Trained personnel will be responsible for each section to ensure the system runs in the most optimal manner possible. Because this system will be relied upon nationally, a backup system must also be in place to address any unexpected technical failures. Monitoring will be continuous, beginning from the point at which professional designers and IT technicians are brought on board and continuing through implementation, commissioning, and beyond.

The proposed cloud-based, interoperable EMRS represents a meaningful step forward for electronic health record management in the United States. By linking existing vendor systems through a standardized gateway, assigning unique patient identifiers, and empowering both providers and patients with real-time data access and control, the proposed system directly addresses the fragmentation and inefficiencies that currently hamper inter-institutional patient information exchange. Successful implementation will require stakeholder buy-in, technical coordination, and sustained investment in training and maintenance—but the gains in patient safety, care efficiency, and data integrity make this a worthwhile and necessary endeavor.

References

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