The sending of updates, patient portals and a vision of a
Web-based electronic medical record transferring
the record to another physician are just as
feasible with client/server applications. For true
interoperability, the industry needs to find a
common denominator for the input of data. By using
a granular method of data input -- where, for
example, clicking a plus sign (+) would signify
a positive finding for, say, nausea, and a minus
sign (-) would indicate no nausea -- a computer
will be able to understand whether the patient
has nausea, no matter what EMR the doctor is using,
Web-based or client/server.
The information must have context, and for context,
there must be a hierarchy. The hierarchy does not
have to be deep, but it must exist. Is
that nausea part of the review of systems or part
of the history of present illness? How long has it
been present? What is its severity? Is this the
primary complaint or an associated symptom?
There is nothing inherent about a Web-based EMR
that will expedite the process of finding a
solution for interoperability. Unless, of course,
the argument is assuming all doctors will use only
one EMR. This is not a valid option right now as
there is no dominant EMR that satisfies
all niches in the medical community -- hospitals,
group practices, solo practices, independant
practice associations, etc. Even within the market
segments, there is not a clear leader.
The dilemma the industry is faced with is not how
to get the patient record from one provider to the
next. The issue at hand is sending an
electronic file from one EMR to another and have
the second EMR electronically register that the
patient was diagnosed with diabetes
in the year 2000, they are due for a diabetic foot
exam, eye exam and a hemoglobin A1C check. Also,
graphing their laboratory results, alongside their weight
and other variables, would further help the new
provider's ability to
efficiently assist in the patient's care.
The common denominator to any EMR that is
interoperable will be granularity. A computer will
not be able to read and understand text
files or PDFs in a manner that promotes
interoperability. But a computer can discern that
a patient has any number of diseases, signs or
symptoms if the data was input in a granular
fashion -- pointing and clicking rather than
and trainingMedtuityColumbus, Ohio
Thanks for VistA history lesson
Fascinating story on VistA -- got to remember that capital A. For many of us, software comes on a shiny CD, seemingly devoid of a history or a
pedigree. Yet all these programs do have a past, a history that provides important clues to the interoperability challenges everyone is wrestling
As famed historian George Santayana said a hundred years ago, "Those who cannot remember the past are condemned to repeat it."
The article on VistA helps us understand the history of healthcare software.
James HarrisPresidentWestside Public RelationsLos AngelesTo submit a letter to YOUR VIEWS, click here . Please include your name, title and hometown.