I have been a Family Practitioner for almost 20 years. When I decided to implement an EMR in my 4 office, 5 doc practice 8 years ago, the term “interoperability” was not one that I frequently used. None-the-less, I was increasingly frustrated when patients saw me in more than one office, and I did not have their medical records. Instead, I had to fax a portion of it. The sheer coolness of an EMR was surprisingly matched by a first year ROI of $60,000 and a huge increase in productivity. But “interoperability” between offices was the biggest benefit.
Because of my evangelical-like advocacy, I was tapped to be the physician champion and later CMIO for a CPOE project at my community hospital. We immediately had 100% adoption, resulting in nearly 80% reduction in pharmacy errors within the first 6 months alone. Don’t let me imply that this was easy, I still have the scars on my back to prove it. Asking dedicated physicians, who are at the top of their game, to change the way that they practice always requires a leap of faith. Decision support remains an unmet mandate. Alert fatigue and lack of true enterprise-wide intelligent rules continues to frustrate. Still, it gives me great pleasure to know that 4 years later, almost everyone agrees that they could not go back to paper.
Needless to say, continuing to practice primary care medicine, while having the experience of EMR adoption in both the ambulatory and acute care settings, has given me a rather unique perspective on the needs, benefits, and frustrations of data sharing.
In my current role overseeing semantic interoperability projects, I have come to understand the further complexities of incomplete ontologies, imperfectly controlled medical vocabularies and the insanity of multiple standards. What I used to think was a rather esoteric area of medical informatics, has now become almost an obsession (OK, I admit I’m a geek). The truth is, many of the problems facing healthcare today, will only be solved when we can easily start exchanging knowledge—not just data—while maintaining a reasonable work-flow.
The purpose of this blog is to shed some real-life perspective on these issues. Hopefully, I can educate a little, while learning a lot.
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