The U.S. Department of Veterans Affairs selection of the same EMR used by the Department of Defense has the potential to reduce fragmentation and enhance care. But, simply picking the same EMR will not be enough. Part I of this series looked at EMR-to-EMR data exchange and health records portability. In Part II, we look at the need for specialized, advanced digital health applications, how robust integration can unleash the real value of EMRs and why both are essential to building the military health and civilian health systems of the future.
In Part I of this series, we made the case that the U.S. Department of Veterans Affairs (VA) selection of the same EMR being adopted by the Department of Defense (DoD), will not, in and of itself, solve the problem of fragmented medical records and better care. We looked at how active duty military, veterans and their dependents receive care from a hybrid of public and private health care providers and regularly move between the DoD, VA and civilian health systems. We also examined how EMR-to-EMR integration is limited and that even using the same brand of EMR is not the same as being on the same EMR.
Unfortunately, the challenge is much larger than just making sure a patient’s medical record follows them from place to place and is readily available to both the patient and their care team. Fortunately, with this challenge comes the opportunity to unleash greater value from EMRs and truly innovate health care delivery.
Robust interoperability is about much more than simple records portability.
Obviously, moving patient records from one place to another is an important aspect of interoperability. But it is not enough. True interoperability enables a symphony of applications that connect, exchange and collaborate. It encourages innovation by enabling market-driven competition to produce the best applications at the best price. Without this kind of interoperability, customers become highly dependent on their EMR vendor’s ability to innovate and are limited by that vendor’s ability, resources and priorities. There is evidence to suggest this stifles innovation and negatively impacts usability, satisfaction, efficiency and clinical outcomes.
Consider just two examples that will be critical to the DoD and VA: Telehealth and Injured Warrior applications. The case for telehealth in the military pretty much makes itself. Suffice it to say that, given the combination of global operations, complex medical needs and limited staff, telehealth will be an essential ingredient. And not just any telehealth system will do. This one will need to be “military grade.” Are we satisfied that current EMR vendors have the best possible technologies?
Or, consider the emerging class of “Wounded Warrior” applications. The combination of advances in battlefield medicine, asymmetric warfare (like I.E.D.s) and extended, multiple tours of duty, have resulted in many more soldiers surviving far more complex injuries than in the past. Wounded Warrior applications are designed to improve the diagnosis and treatment of the unique physical and psychological injuries sustained on the modern battlefield. They represent a great hope for better care, but also a great challenge when it comes to interoperability. Like most digital health solutions, they are of limited use unless tightly integrated into clinical workflow, which often requires robust interoperability with the EMR.
Too often, EMR vendors lack the knowledge and resources to develop these kinds of specific applications. APIs provide the robust interoperability that these applications require to unleash the true value of an EMR investment and empower a whole new generation of solutions. Of course, these same concerns apply to private health systems as well. They also need to innovate and be free to choose the technology that aligns best with their strategies.
In summary, while the VA’s decision to migrate to the same EMR platform as the DoD is a sound one, it will not, in and of itself, solve the interoperability problem. This problem is almost identical to that faced by private health systems and extends far beyond data exchange for simple records portability. Military and civilian health systems must also be free to select the most innovative applications and seamlessly connect them with core EMR systems. Simultaneous pursuit of a broad, robust, API-based approach to application integration will be crucial to achieving the vision and delivering the world-class care that our active military, veterans and their families deserve. Given their sacrifice for us, it is the least we can do.
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Dave Levin, MD is the Chief Medical Officer for Sansoro Health where he focuses on bringing true interoperability to healthcare. Dave is a nationally recognized speaker, author and former CMIO for the Cleveland Clinic. He has served in a variety of leadership and advisory roles for Health IT companies, health systems and investors. You can follow him @DaveLevinMD or email Dave.Levin@SansoroHealth.com.