February 18, 2011 10:45 PM

I was talking with a colleague last week about EMR adoption. He expressed his frustration at the lack of coding and interoperability standards between different EMRs available in Canada.

Frequently over the past few years I have written about the importance of structured and coded data for the analysis, management and transfer of health information. The implications are numerous. If data is going to be transferred from one system to another (whether for clinical or administrative purposes) it needs to have the same meaning in both systems. It goes without saying that if I order a laboratory test which is then reported upon, I expect the result to be imported and stored in the correct patient’s file. Similarly, if I transferred a chart from my system to another, I would expect that the data would be transferred in the right format for import into the receiving EMR.

All of this assumes that data is coded using commonly accepted standards and that all EMR vendors use the same reference measures. Makes logical sense, right? The explosion of mobile smart phones in the past 12 months is only possible because of an adherance to standards for software design and data sharing. Imagine if your mobile phone could not speak to another. If you could only text message individuals using the same network or send Gmail only to other Gmail users. It would not be very effective or satisfying.

I would like to point out that this is not the fault of the EMR vendors. While they can be criticized for developing systems that have proprietary databases or data structure that make it difficult to move from one EMR to another, this is not unique to EMRs. The software industry has been built on having closed proprietary systems that provide a unique competitive advantage to a specific vendor. When a vendor becomes dominant (as Microsoft did with the Office suite of products), their document/data format can become the de facto standard for the industry. However that is unusual and although one company becomes highly successful, many others fail as a result.

The bottom line is that there is a delicate balance between maintaining a proprietary advantage in the market and ensuring that data is able to move efficiently between one system and another.

A bit of historical background. EMRs in Canada did not evolve from a need to collect and share data. Early EMRs in Canada grew from billing and scheduling systems with the need to collect basic clinical data and code it using ICD9 codes for billing purposes. There was (and still is) no requirement for a clinical user to code diagnoses accurately. For example, if a patient is seen with an obscure GI diagnosis and the treating physician does not know the exact ICD9 code, a generic code such as 787 — “symptoms involving digestive system” can be used without fear of penalty. Without a stringent requirement for accurate diagnostic coding, the historical diagnostic data might be useful to the individual physician, but completely useless for population analysis or even sorting of patients within a practice for recall purposes. Garbage in ... Garbage out.

There are efforts underway to establish standards for data sharing between different EMR systems for the purposes of sending and receiving referral requests and consultation reports. However, is this sufficient? Should all EMR systems in Canada be migrated to use the same data structure and coding standards (e.g. by 2017)? Or should the focus just be on specific areas such as ePrescribing or Referrals?

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Posted by Sue Ansell at February 18, 2011 10:45 PM

Categories: eHealth

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