Factors Limiting EHR Implementation and Adoption
A recent article posted in the New England Journal of Medicine (NEJM) describes some of the factors limiting broader deployment and implementation of electronic health records (EHRs) across healthcare. EHR systems are intended to streamline health-related information and translate developments from research to practice more rapidly. Broader utilization of EHRs across the industry requires addressing the current limitations.
Different EHRs vary, even those created by the same vendor. The alterations occur because systems are usually modified to meet the distinct needs of each user and modifications are unique to each facility or institution.
The first issue noted is the lack of common vocabulary across distinct EHR systems. This means that health records across different healthcare systems or institutions can often not be shared. This also complicates data collection for research efforts or comparison of data across facilities.
This is particularly relevant for new post-market surveillance studies proposed by the FDA to assess drug and device safety and efficacy. Post approval efforts could be improved by compiling data from clinical practices including patients with particular devices or taking medications of interest. Collation of such information has the potential, further, to identify issues which may not otherwise come to light.
The FDA currently houses an array of data from completed clinical research efforts. This vast information cannot be used to compare various products, in part because data is stored in a variety of formats.
The article describes the need to develop data standards across the healthcare industry that should also be applied to medical research settings. One consideration in the development of such is the ability to share information, so that data from disparate sources can be collected into a unified database.
One particular benefit of the development of such a platform is the ability to compile information from across the country to assess a wide variety of research questions. This can additionally be leveraged to provide guidance for healthcare decision making that can be utilized by clinicians and patients alike.
The Health Level 7 (HL7) has been creating standards to guide practices related to health information exchange. The Clinical Data Interchange Standards Consortium (CDISC), alternatively, is developing standards related to data used for medical research.
The two organizations began collaborating in 2001 to synchronize standards. They created the Biomedical Research Integrated Domain Group (BRIDG) model. This is a set of standards specific to the medical research domain. The model was created to support use of similar languages across various EHR iterations.
Integrating the Healthcare Enterprise (IHE) is a program that supports integration of data collection during routine clinical practice, including collection of adverse event data and completion of related clinical research activities. Authors of the NEJM article note that the IHE can also aid in global clinical trials registration.
Though progress is being made by the groups described above, many obstacles still exist. Some healthcare organizations were early adopters and integrated EHRs before the creation of standards. They are now faced with changing to a new system in order to be able to share information easily.
These efforts, nevertheless, must continue forward. Experts across the healthcare industry repeatedly site the significant opportunities afforded by EHR adoption, including improvements to patient safety and the quality of care delivered routinely. Another key benefit, alluded to herein, is the ability to leverage data from clinical care to support research investigations. That opportunity has yet to be fully realized because of current limitations in the data system.
April 24, 2008 Related topics: General Management & Administration, Standards, Trends, Partnerships & Consortia, Quality, Safety, Errors