Doctors Blame EHR Vendors for Medical Records Integration Problems

Loraine Lawson

Integration is among the greatest — if not the greatest — obstacles to electronic medical records and the cost and health benefits that would bring. It’s assumed this is a problem of too many legacy systems and specialized technology challenges unique to health care.

But what if it’s not about that at all. What if the problem is actually a myth propagated by niche vendors who want to scare doctors and hospitals away from better tech solutions?

Then, integration and all those other data issues could be readily addressed by existing enterprise solutions, right?

In the recent issue of the New England Journal of Medicine, two doctors claim just that, calling out electronic health records vendors:

We believe that EHR vendors propagate the myth that health IT is qualitatively different from industrial and consumer products in order to protect their prices and market share and block new entrant. In reality, diverse functionality needn't reside within single EHR systems, and there's a clear path toward better, safer, cheaper, and nimbler tools for managing health care's complex tasks.

As a result, contends Drs. Kenneth D. Mandl and Isaac S. Kohane, these niche vendors are keeping physicians “locked into a pre-Internet-era electronic health records.”

The piece goes on to point out that many of the integration challenges are actually manufactured by EHR vendors who refuse to support widely accepted standards and interoperability, even in the data. There are more than 700 EHR vendors producing about 1,750 distinct, certified products, but most are not interoperable, according to the article.

Shahid Shah, an enterprise software analyst who specializes in health care and "regulated IT" systems, responded to their charges in a Radar O’Reilly article. Shah doesn’t even bother to defend the industry, noting that the methods and approaches health care IT uses for integration are “opaque, decades old, and they reward closed systems.”

Instead, he deepens the critique by specifically identifying what needs to change in EHR systems.

One very alarming point: “When health IT systems produce HTML, CSS, JavaScript, JSON, and other common outputs, it's not done in a security- and integration-friendly manner.” (Emphasis added by me.)

Fan-freakin-tastic. Good thing we have to sign all those HIPAA forms, huh?

I have to say, I love that Drs. Mandl and Kohane dared to point out the Emperor’s (alleged) nakedness.  I suspect — and deeply hope — we’ll see more of this sort of thing across the tech industry as more technology-savvy workers move into professional fields.

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