Interoperable Computing

How Important Are Interfaces in an EHR?

EHRs are great at collecting, storing, and sorting information in a format that be easily retrieved for later review or analysis. However, some of the most important features in an EHR are those that allow information to flow seamlessly between organizations including hospitals, medical practices, diagnostic facilities, and laboratories. One of the regular frustrations we hear from physicians is the inability of their EHR to link with these facilities and automatically download the information and reports into the EHR. Interfaces can be costly to implement and, if EHR software is updated, it may require additional maintenance.

Effective operation of interfaces is critical if one wants to create high performing medical practices. However, there are many challenges as reflected in the following user comments on EHR interfaces:

  • We use the EHR to interface with our operative scheduling. The diagnosis codes are not written in any logical fashion and you have to remember how they are coded. For example, hernia repair does not bring up herniorrhaphy and vice versa. If you put the diagnosis in one part of the system, it ought to go into the other part, but it doesn’t. The billing codes are organized differently in different locations and are inconsistent.
  • Our EHR has improved safety and ease of communication. However, my work days are substantially longer due to the cut and paste nature of the system. My training time was two hours of an online module — an absolute joke in view of the complexity and idiosyncrasies of the system. To enhance decision support, we need to interface research and clinical registries, which is proving to be very difficult.
  • Probably has other features, but has a high cost of training (including opportunity costs of lost patient care time) to use additional features, so I quit doing the additional training. The lab interface merges records by name rather than social security number. If the merge isn’t exact, the EHR creates a new chart, then requires someone to merge charts. This is too time intensive, so I just keep paper labs.
  • This is a powerful program that we were given little to no training to operate (less than two hours before go live and approximately one week of trainers in the office). The problems that we are running into are often caused by the “new box effect.” Our practice was not allowed to benefit from the experience and refinements of previous practices in the group that had been live longer than us. We feel that we are re-inventing the wheel all the time. It is the customizations and interfaces which make the EHR successful.
  • The main issue I have is that the EHR is not linked to the hospital. All dictated documents from the hospital have to be scanned into the chart. They are all scanned under the same name, so to look for a specific report is very difficult. In addition, radiology reports are also not linked and difficult to search for results.

Have you had good or bad experiences using interfaces with your EHR? Do you have any advice for colleagues?

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