Everyday I face issues that are related to the underlying workflows that breakdown because of a lack of a fully integrated Electronic Medical Record. There are too many challenges associated with the "best of breed" or "best of suite" application mix not working together. There are different operating systems, databases, data dictionaries and user interfaces that drive the applications. Simply creating a standard based interface, like HL7 2.x, creates a interpreter between the two systems, but there is a lot lost in translation. I worry that interfaces have the potential to cause more harm than good if there is a misinterpretation that creates a bad outcome as a result. The context in which the information is captured is critical to the understanding of the full meaning of the data that is being transmitted. Without a fully integrated EMR where all the applications are defined and delivered out of the same database, there is a risk of this happening.
Health Information Exchanges (HIE) and standards organizations, like the Health Level 7, have made some progress is improving this situation with semantic interoperability. This concept is based around capturing the meta data surrounding the data to create the "context" and as a result, improve the integrity and reliability of the data. This is a time costly and resource intensive way to accomplish only part of what a fully integrated EMR can do.
We are on a path towards a fully integrated EMR. I just wish we could get there sooner!
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