More research, clinical ops collaboration would benefit EHR integration

EHRs need to do a better job of collecting clinical data to enable research informatics, but vendors aren’t the only ones to blame for this elusive functionality.  Researchers and clinical staff responsible for EHR configuration must be better collaborators, according to a Sept. 1 perspective published in the Journal of the American Medical Informatics Association. 

“For EHRs to be truly useful and not just an electronic version of a paper chart, their design must change,” wrote Keith Marsolo, PhD, director of software development and the data warehouse at Cincinnati Children’s Hospital. “It must be easier to create data collection forms and other interfaces that are easily integrated into the clinical workflow yet are tied to underlying data elements that are common across the vendor's system.”

Marsolo and his colleagues built an electronic self-reporting survey tool that incorporated computerized clinical decision support (CDS) and risk stratification for the purpose of monitoring medication adherence. As a standalone tool, it could have been expanded to include additional functions and easily implemented at low cost, but integrating the tool into an EHR was impossible. The CDS and risk stratification functions had to be abandoned for EHR integration, leaving just a function for calculating adherence scores that had to be entered into the EHR manually. 

There are two problems, according to Marsolo. It is difficult to automatically input data into EHRs, which could enable functions like CDS, and to get data out of EHRs, which would enable research informatics. Available health data storage specifications, such as the Health Level 7 Continuity of Care Document, are sophisticated, but unsuitable for research, he suggested. 

If vendors were to publish their products’ application programming interfaces, that would be a big first step. Marsolo suggested an “Apple approach," in which an established set of design patterns and an approval process for developers to deploy tools would allow an ecosystem of services and applications external to EHRs. 

Vendors can do more to facilitate a developer-friendly ecosystem, but so can researchers and clinical staff responsible for EHRs. “While the informatics community needs to push for change in the design of EHRs, at the same time it needs to become more involved in their configuration and implementation,” Marsolo wrote. “For years, the relationship between clinical operations and research at most institutions ranged anywhere from non-existent to hostile, to, in the best cases, something close to benign neglect.”