• EHRs and HIEs have a few IOp holes

    “Everything in strategy is very simple, but that does not mean that everything is very easy.” That’s how the Prussian military strategist Carl von Clausewitz sees it. Semantic Interoperability (SIOp) might be similar. A strategy for SIOp is unavoidable, but it doesn’t always convert into practice. A very important review by a team of eleven researchers of EHRs’ and HIEs’ SIOp, in the Journal of the American Medical Informatics Association (JAMIA), found eleven holes.

    They’re summarised in a table as:

    Omissions or misuse of Logical Observation Identifiers Names and Codes (LOINC) in results or vital signs Omission or misuse of Systematized Nomenclature of Medicine (SNOMED) in problems Excess precision in timestamps Omission or misuse of Unified Code for Units of Measure (UCUM) in medications, results or vitals in a Consolidated Clinical Document Architecture (C-CDA) for document exchange Omission or misuse of RxNorm, the USA’s catalogue of standard names for clinical drugs and drug delivery devices, in allergies and medications Omission or misuse of dose quantity Omission or misuse of allergic reaction Omission or misuse of allergic severity Omission of dose frequency Omission of results interpretation Omission of results reference range.

    The researchers classify each item as an error, heterogeneity in C-CDA documents or both. These errors limit semantic interoperability. They also provide a schedule of work needed to improve C-CDA document quality and exchange.

    The study shows the challenges of effective accreditation and certification, and the precision needed to achieve SIOp. It’s extremely valuable to all healthcare organisations already dealing with SIOp in their EHRs and HIEs, and for ones about to embark on their SIOp endeavour.

    As African countries develop their eHealth regulations, the study’s findings show a way ahead for some of the content and detail needed for the accreditation of eHealth suppliers. The precision that the study used transfers from accreditation to the detailed assessment of suppliers’ EHRs and HIEs needed for procurements, then onto successful SIOp.

    Clausewitz also thought that “Part of strategic success lies in timely preparation for a tactical success.”The study shows that even certification isn’t enough for a successful SIOp strategy. The study’s findings are part of the solution.

  • HIE benefits are huge, but not automatic

    A study from HEALTHeLINK, the USA health information exchange (HIE) company, says that Western New York’s health system could have saved $1.3 million in avoidable, duplicate computed tomography (CT) scans. The HIE shows the tests for each patients, so can reduce unnecessary duplicative tests, saving money and improving patient safety when tests involve exposure to radiation. The researchers say that the $1.3 million is a conservative estimate.

    The findings include:

    An estimated 2,763 CT scans deemed potentially unnecessary duplicative tests over 18 months About 90% of these CT scans were ordered by physicians who never or rarely used HEALTHeLINK About 50% of patients who had duplicative CT scans had already consented to data access Only 2.3% of patients denied consent Over 95% of the unnecessary CT scans were in hospitals The lost opportunity by using HEALTHeLINK before ordering CT scans could save about $1.3 million.

    This study shows large potential benefits from HIE. It also reveals the challenges of converting eHealth benefits, which need a considerable investment in change, because benefits are not automatic. HIE alone is not enough. African countries’ eHealth strategies need to reflect this for realistic plans.