Interoperability of electronic medical records requires more than just technical understanding

Affleck, Ewan

doi:10.1503/cmaj.71818

Cited by 6 publications

(6 citation statements)

References 2 publications

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“…Interoperability of EMR systems is also a known challenge to conducting research in different contexts [ 54 – 57 ]. Often, specific data needs to be excluded when there is a lack of consistency across the various networks.…”

Section: Discussion: Key Challenges and Lessons Learnedmentioning

confidence: 99%

Strategies for working across Canadian practice-based research and learning networks (PBRLNs) in primary care: focus on frailty

et al. 2021

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Background Practice based research and learning networks (PBRLNs) are groups of learning communities that focus on improving delivery and quality of care. Accurate data from primary care electronic medical records (EMRs) is crucial in forming the backbone for PBRLNs. The purpose of this work is to: (1) report on descriptive findings from recent frailty work, (2) describe strategies for working across PBRLNs in primary care, and (3) provide lessons learned for engaging PBRLNs. Methods We carried out a participatory based descriptive study that engaged five different PBRLNs. We collected Clinical Frailty Scale scores from a sample of participating physicians within each PBRLN. Descriptive statistics were used to analyze frailty scores and patients’ associated risk factors and demographics. We used the Consolidated Framework for Implementation Research to inform thematic analysis of qualitative data (meeting minutes, notes, and conversations with co-investigators of each network) in recognizing challenges of working across networks. Results One hundred nine physicians participated in collecting CFS scores across the five provinces (n = 5466). Percentages of frail (11-17%) and not frail (82-91%) patients were similar in all networks, except Ontario who had a higher percentage of frail patients (25%). The majority of frail patients were female (65%) and had a significantly higher prevalence of hypertension, dementia, and depression. Frail patients had more prescribed medications and numbers of healthcare encounters. There were several noteworthy challenges experienced throughout the research process related to differences across provinces in the areas of: numbers of stakeholders/staff involved and thus levels of burden, recruitment strategies, data collection strategies, enhancing engagement, and timelines. Discussion Lessons learned throughout this multi-jurisdictional work included: the need for continuity in ethics, regular team meetings, enhancing levels of engagement with stakeholders, the need for structural support and recognizing differences in data sharing across provinces. Conclusion The differences noted across CPCSSN networks in our frailty study highlight the challenges of multi-jurisdictional work across provinces and the need for consistent and collaborative healthcare planning efforts.

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Section: Discussion: Key Challenges and Lessons Learnedmentioning

confidence: 99%

Strategies for working across Canadian practice-based research and learning networks (PBRLNs) in primary care: focus on frailty

et al. 2021

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“…Furthermore, given the nature of the private industry in which EMR vendors operate, there are limited regulations and standards that companies comply with across the board [ 42 ]. This means that when different facilities take on different vendors as their IT solution proponents, standardization of how the system is used and how it communicates is undetermined until initial adoption [ 42 ]. The process by which vendors are selected is a serious factor with political influence that affects interoperability and data digitization.…”

Section: Discussionmentioning

confidence: 99%

Proposed Implementation of Blockchain in British Columbia’s Health Care Data Management

et al. 2020

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Background There are several challenges such as information silos and lack of interoperability with the current electronic medical record (EMR) infrastructure in the Canadian health care system. These challenges can be alleviated by implementing a blockchain-based health care data management solution. Objective This study aims to provide a detailed overview of the current health data management infrastructure in British Columbia for identifying some of the gaps and inefficiencies in the Canadian health care data management system. We explored whether blockchain is a viable option for bridging the existing gaps in EMR solutions in British Columbia’s health care system. Methods We constructed the British Columbia health care data infrastructure and health information flow based on publicly available information and in partnership with an industry expert familiar with the health systems information technology network of British Columbia’s Provincial Health Services Authorities. Information flow gaps, inconsistencies, and inefficiencies were the target of our analyses. Results We found that hospitals and clinics have several choices for managing electronic records of health care information, such as different EMR software or cloud-based data management, and that the system development, implementation, and operations for EMRs are carried out by the private sector. As of 2013, EMR adoption in British Columbia was at 80% across all hospitals and the process of entering medical information into EMR systems in British Columbia could have a lag of up to 1 month. During this lag period, disease progression updates are continually written on physical paper charts and not immediately updated in the system, creating a continuous lag period and increasing the probability of errors and disjointed notes. The current major stumbling block for health care data management is interoperability resulting from the use of a wide range of unique information systems by different health care facilities. Conclusions Our analysis of British Columbia’s health care data management revealed several challenges, including information silos, the potential for medical errors, the general unwillingness of parties within the health care system to trust and share data, and the potential for security breaches and operational issues in the current EMR infrastructure. A blockchain-based solution has the highest potential in solving most of the challenges in managing health care data in British Columbia and other Canadian provinces.

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“…Virtual care for older Canadians represents an (as yet unfilled) opportunity to integrate oft-siloed health services. However, effective design and implementation of this sort of virtual care would require a culture change, collective compromise, and continual adaptation to achieve the Quadruple Aim (Affleck, 2019).…”

Section: Need For User-centred Designmentioning

confidence: 99%

Aligning Virtual Care in Canada with the Needs of Older Adults

et al. 2022

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Public health measures associated with coronavirus disease (COVID-19) have accelerated the adoption of virtual health care across Canada. We explore the opportunities that virtual care presents in achieving the Quadruple Aim and challenges to navigate, through the lens of care for older adults. In particular, we recommend virtual care-related policies related to older adults that address (a) limited uptake among the socio-economically disadvantaged, (b) user-centered design of virtual care technologies, and (c) integration of iterative evaluations to ensure equitable and efficient achievement of desired outcomes. As virtual care accelerates forward, we must not leave older Canadians behind.

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Interoperability of electronic medical records requires more than just technical understanding

Cited by 6 publications

References 2 publications

Strategies for working across Canadian practice-based research and learning networks (PBRLNs) in primary care: focus on frailty

Strategies for working across Canadian practice-based research and learning networks (PBRLNs) in primary care: focus on frailty

Proposed Implementation of Blockchain in British Columbia’s Health Care Data Management

Aligning Virtual Care in Canada with the Needs of Older Adults

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