Internal integration woes seen in EHRs

When it comes to interoperability of healthcare information technology systems, much of the focus has been on data standards and health information exchanges to promote the external swapping of information between one provider armed with an electronic health-record system and another.

But the lack of interoperability within systems is also a problem when it comes to maximizing the potential of EHRs to access the latest medical information and deliver it in a usable format for clinicians, according to new report from KLAS Enterprises, the Orem, Utah,-based health IT market research firm.

In a just-released report, KLAS looked at three classes of third-party developed products and tools designed for use with the clinical decision-support functions of EHRs, (which KLAS refers to in its report as electronic medical-records systems, or EMRs.) The three classes of outside-developed products studied are clinical order sets, care plans and drug databases. The supposed added value supplied by vendors of these products is that the vendors keep the products current with the forever changing and expanding bodies of knowledge in each of the three categories, freeing providers from having to do that work themselves.

The good news for vendors of these products is, according to KLAS, one-third to almost half of providers using one of them—depending on category—had previously tried the do-it-yourself approach and gave up.

The bad news is, to make the products most useful, they need to be fully integrated into a clinician's workflow, and to do that, they also need to be fully integrated into the EHRs that clinicians use—and that doesn't always happen, according to KLAS.

For example, about half of the 249 providers KLAS contacted for the report indicated that they use order sets from third-party developers only as a reference and do not fully integrate the orders into their own EHRs “because they were unable to efficiently move” these components into their own systems. Workflow integration and the actual display by the EHR “was the area most frequently requested for improvement,” the report said.

Care plans fared better, with higher levels of EHR integration. Only one in five healthcare providers that used vendor-supplied care plans was using them only as a reference, the report authors said.

Drug databases fell somewhere in the middle.

Providers told KLAS researchers they were “only moderately successful” in managing medication alerts. Providers would like more control over them, allowing them to customize the alerts as they see fit.

Dealing with too many drug alerts was the biggest problem providers cited in reference to drug database products, so much so that “alert fatigue” was reported as “a significant concern for patient safety,” according to KLAS. One provider—a 220-bed hospital—reported devoting the equivalent of one full-time employee and a half-time employee “to stay on top of managing the alerts,” the KLAS researchers said.

On the plus side, of the top five clinical decision-support product vendors mentioned across all three CDS categories, drug database provider First Databank, which also had the largest market share in the drug reference category, earned highest praise from customers and from KLAS for its ability to integrate with a “wide variety of EMRs.” As such, its clients were most likely to use functions more advanced than basic drug-drug and drug-allergy alerts, the researches said.

The bottom line, according to KLAS, is that developers of EHR systems need to step up to the plate on internal integration issues.

“All EMR vendors need to become more active in enabling providers to leverage evidence from third-party solutions,” the report authors said. “Too many providers struggle to get evidence-based data into the EMR and then use it effectively once embedded.”