There is clearly a lot of excitement around getting your EHR connected to external interfaces. Some practices are feeling pressured by Meaningful Use Requirements, others feel pressure from payers, regional hospital systems and other third party entities. You may be geared up and ready, but is there someone blocking the road? There may be several barricades, and they may not be what you think. So let’s take a closer look at what’s potentially getting in the way.
Could it be there is a single tollbooth operator? In some cases, the answer is definitely “yes”. Think about all the new cars trying to get on the highway. There are hundreds of EHR vendors that have to write interfaces. Then each interface needs to be tested for quality assurance. In some cases, EVERY practice that uses the same EHR has to be tested for the quality of EACH connection before going live. I have recently learned that in one nearby state, there is ONE (yes 1!) person for the entire state IIS that is doing this quality testing. The single toll booth operator is creating a tremendous bottleneck for the entire information highway and there is no EASY PASS!
Could it be that different people are building the road differently? “Absolutely!”, you may say “but aren’t there standards by which everyone is supposed to be building the same road?” You would be correct. But unlike the federal highway commission, there is no one holding these entities accountable for following the mandated standards. Many states and regions have the attitude that they are special and have unique needs which they consider very good reasons for why they subtly (or in some cases, not so subtly) altered the standard. That’s fine on their end, but it means that EVERY EHR vendor who wants to support their unique Health Information Exchange (HIE) or Immunization Information System (IIS) has to write different software code to support every highway they have built. Imagine each individual road setting up its own toll payment system. Every person who drives through different booths has to have a different Easy Pass to pay for every road they may drive on. Convenience and efficiency rating—zero.
Could it be that some entities are repaving roads, creating detours, and not telling anyone about the changes until they are already driving? You bet! Many of the HIEs and IIS are updating their own internal software to more robust platforms. They change their software code, which changes their interface, but they do not, and often will not proactively notify their vendor partners. It isn’t until your interface is no longer working that the EHR finds out that there is a detour, and the interface needs to be adjusted in order to keep your information flowing. It’s a construction project in progress without notification, and no time to plan or adjust accordingly.
Could it be that in some cases the superhighway is getting closed down and replaced by smaller roads? “Yes” to this one as well! Let’s take Michigan for example. They have had a pretty robust State IIS for a while. The single Michigan IIS interface is getting phased out and being replaced by…hold your breath…SIX regional HIEs. More construction, more interfaces to develop, deliver and support. And what if you happen to practice in an area that is close to a few HIEs? Instead of one interface, you might have to connect to multiple interfaces! The good news is that we are starting to connect to each other. Just one word of caution: when you venture out for that road trip, take along some good reading material because you will likely be stuck in traffic.