Report offers solutions to sluggish interoperability standards adoption

July 27, 2005

National electronic medical record implementation faces an uphill battle in the U.S. Healthcare continues to lag behind business sectors such as international banking in developing standards for electronic data exchange, according to a new report from the California Healthcare Foundation.

National electronic medical record implementation faces an uphill battle in the U.S. Healthcare continues to lag behind business sectors such as international banking in developing standards for electronic data exchange, according to a new report from the California Healthcare Foundation.

The 27-page report provides a general overview of clinical data standards and highlights a number of case studies that exhibit how different organizations are using those standards to implement interoperable software solutions.

Ideally, a single set of standards for image, text, and numerical data would allow healthcare information to be easily accessed and shared by providers, payers, regulators, and consumers, the report said.

Healthcare's progress in this direction has been exceptionally slow. It took the Internet just three years to make its first 10-fold expansion, but it has taken 25 years for the Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT) to gain adoption by just 16% of the industry.

"To move from a handful of early adopters to mass adoption of clinical data standards, a great deal more movement is needed," the report said.

It cites lack of funding as a primary barrier. The case studies in the report used different financing strategies including internal funding, foundation grants, and startup funding from sponsoring insurers.

Funding is necessary but insufficient to ensure successful change, according to study results. Other factors need to be considered as well. Cultural change, for example, is required for independent entities to share data previously held within an organization's own walls.

Hospitals may see technology as a competitive differentiator in terms of physician relations and patient perception and fear relinquishing this advantage by participating in a shared system with other hospitals. In a case study of Taconic IPA, a healthcare delivery network in the greater Hudson Valley in New York, this concern was overcome by physician and hospital leadership cooperation.

Another barrier is the perception that standardization means loss of local autonomy.

At PeaceHealth, a six-hospital system in the Pacific Northwest, clinicians were concerned they would not have flexibility to meet local needs. The report says the collaborative decision-making process the system undertook helped address these concerns.

The implementation team at PeaceHealth created cross-regional workgroups to define requirements, agree on terminology, share lessons learned, and brainstorm future uses of technology. Implementation at each facility built on lessons learned at previous sites, and additional time was allocated to ensure the system worked within the local business process and culture, the report said. Leadership there constantly reinforced the message that standardization was a means to improving patient safety and quality.