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#HI201 #EA @kidseyes88

1) Will open EMR prevent this? Billing dispute leads to blocked patient data in Maine… via @BostonGlobe

No it will not. There are at least three layers of interoperability that need to exist before data flows effectively — business, information, technology. Open electronic medical records can address information and technology interoperability but cannot assure that there will be business interoperability (that is, two entities agreeing to do business with each other). The article is interesting that it actually states that information and technical interoperability already existed but a disagreement in how to run the business prevented the exchange of information. Similar cases abound in healthcare.

2) Doctors Find Barriers to Sharing Digital Medical Records

In the US, the EMRS got bigger before the Health Information Exchanges became mature (the information and technology interoperability layer). In such a situation, it becomes harder for mature EMRS (like EPIC) to connect “back” to an HIE (this is logical because the EMR has more features than an emerging HIE). The lesson is to quickly define the HIE and ask the EMRs to connect to it.

3) Is interoperability addressed by using open EHR?

Up to a certain point but not beyond it. openEHR helps organize clinical knowledge and structure it consistently. That helps with managing the complexity of clinicians having varying ways of representing their knowledge (see the mindmaps of those who participated in the openEHR workshop). All group members were given the same clinical scenario but all groups have varying mindmaps for that case. If they proceeded to create the EMRs from the mindmap, for sure, their EMRs will not be interoperable because they had already diverged at the clinical knowledge layer.

openEHR is like a bucket of lego blocks from where you can get pre-built blocks (representing clinical knowledge) which you can then put together to create your EMR. Since all of you got your building blocks from the same bucket, the chances that your EMRs can connect is higher.

4) First things first, EMR for different departments in PGH and make them interoperable, fully accessible by healthcare provider?

First definitions: an EMR is an electronic system for recording patient data in one facility. An EHR on the other hand is a person’s longitudinal record which may comprise of data coming from different EMRs.

So in PGH, ISIS is the EMR of the Department of Surgery. In IM, they have their own EMR. But patient Juan dela Cruz should only have one EHR which is a collection of his data from Surgery and IM.

How is this possible? Through interoperability — a system that allows the collection of Juan’s data from the different EMRs where his data resides. Do we need to design this from scratch? No, the Integrating the Healthcare Enterprise ( has already described how this could be done in a health system.

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