Improving EPR interoperability for value-based healthcare: why co-evolutionary dialogues are essential

I wrote this blog post as a response to the following call on LinkedIn by Mark Stoutjesdijk, MD PhD MBA:

I need _your_ opinion!
One week ago at the ICHOM2019 conference, I asked a pressing question at one of the expert panels.
“EPRs are very closed. This hinders [vbhc] implementation. How can other stakeholders force better access to EPR data?”
In short , the answer was that the requiremens of the customers (us!) shape the functionality of EPRs. We want fancy software to optimize billing, so that is what we get.
Do you agree? And if so, how slim are our chances for better interoperability and open access? VBHC interoperability EPR PatientFirst

My answer is formulated below:

I think the statement that requirements of the customers shape the functionality of EPRs is in part true. Herein, process optimization and billing support have been done first simply because the underlying data of these processes are often relatively unambiguous, end users (managers, administrative staff) are relatively easy to access and thus the data is easier to standardize. To achieve interoperability of any software, data standardization is crucial: systems have to “speak each others language”, so to speak, or at least standardized translations should be possible.

I personally think this is where the difficulties lie in interoperability of EPRs: patient data are more complex than billing information and therefore more challenging to pour in standard formats. In my research I see that many hospitals are working toward structured registration of patient data and the implementation of information standards such as SNOMED. These are architectural decisions and provide promising steps in the right direction in terms of improving interoperability, not only within hospital walls but also across healthcare providers.

A downside to this is that structured registration of patient data by physicians takes more time and is less flexible than using free text fields (the latter is still often applied in practice). In part this challenge may be overcome by further development and implementation of comprehensive information standards such as SNOMED so that free text fields become increasingly obsolete. However it still requires adaptations in the way physicians register patient information, which are essentialy behavioural in nature. EPR providers may need to make technical changes to their systems to facilitate this transition, but IT alone is not enough. Input of healthcare professionals themselves is crucial, and healthcare professionals should be encouraged and enabled to play an active role in EPR (interoperability) optimization.

In my view, achieving optimal interoperability of EPRs while maintaining quality of care thus requires a range of steps across healthcare providers’ strategies, architectures and also day-to-day practice of healthcare professionals. Some solutions may lie in technical aspects of the EPRs, some may lie in information architectures and some may lie in changing ways of working or divisions of labour in the healthcare processes themselves. In any case, to get to these solutions I believe a genuine two-way dialogue on these topics with active involvement of EPR specialists, administrative staff and most importantly healthcare professionals is necessary on each of these levels (strategic, tactical, architectural and operational), i.e., co-evolutionary interactions.

In short, to give my view on this matter, I think stakeholders can force better access to EPR data by actively joining the conversation in finding solutions and realizing that these lie in part in IT, and in part in their own ways of working.

I am curious to see your reactions, do not hesitate to join in on the conversation!

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