In 2008, I sat as co-chair on the Canada Health Infoway Clinical Subcommittee (CSC) on standards. At that time, an important part of my agenda was to move forward messaging standards for EMR to EMR interoperability. In fact, it was due to the lack of commitment by Infoway in pursuing this goal that I finally resigned as co-chair and quit the committee. I was informed that EMR standards were #51 on the priority list of Canada Health Infoway's standard collaborative. See National Post article - Avoid the Boondoggle. Top 10 would have been worth fighting for, but #51 was too big a hill to climb at that time.
How this has come back to bite us all. Now that EMRs are well adopted by the majority of physicians across Canada, we have yet to achieve ubiquitous secure messaging capability between EMR systems. It is extremely difficult to reverse engineer this capability into EMR systems, not just to ensure the information is able to flow smoothly and dependably, but with semantic interoperability. In other words, the ability to ensure that information in one system, once transmitted, has the same meaning in the receiving system.
An announcement today in Technology for Doctors, QHR, Telus set to create national messaging standards is a welcome step in this direction. However, it is important to note that it has taken the EMR vendors themselves to move this agenda forwards, while at the same time inviting other EMR vendors to participate in the process. It is my hope that this truly represents the next critical step towards a more seamless and connected system for transfer of patient information between physicians and other care providers, particularly as shared care becomes more prevalent in private practice settings.
The top-down approach may have moved the acute care system and hospitals in the right direction, however they are still not without their difficulties. However, it boggles my mind that we could have missed the importance of EMR-to-EMR seamless interoperability. Particularly because the large majority of care in this country is provided by family physicians and specialists in private practice settings.
Physicians are now becoming restless. There are numerous examples of successful interoperability across the world. MedCom, the Danish Health Data Network is an excellent example.
I anticipate a rising groundswell of physician dissatisfaction with the Status Quo. There is no reason in 2016 that we should still be functioning in practice or product specific data silos.
I hope we get it right this time. After an expenditure of multi-billions of dollars, we should be further along that we currently are.
So, how do we do it differently going forward? What are the key foundational requirements for success and what can we avoid repeating so that in 2025 we are not debating and arguing about the same issues?
Comments and feedback welcome.