Putting a Price Tag on EHR Interoperability
Electronic health records (EHRs) are not working as they should. A John Hopkins study suggested that preventable medical errors, including those due to EHR errors, accounted for approximately 250,000 patient deaths every year – making it the third-leading cause of death in the United States. On top of the tragic loss of human lives, it is estimated that the economic cost from lost productivity as a result of medical errors could be upwards of $1 trillion every year.
When CRICO, a medical professional liability organization, identified 147 cases over five years in which an EHR was identified as a contributing factor, a staggering 80 percent of these cases involved moderate or severe harm to the patient. In total, an estimated $61 million in direct payments and legal expenses resulted from these cases, at an average cost of $415,000 per case. For example, one case that was cited refers to a patient whose height is 60 inches but is recorded as 60 centimeters in the EHR, which distorted her body mass index (BMI). In another case, a short-acting drug was entered into the EHR as the long-acting version that was refilled six times based on the erroneous information. Alas, the true cost of EHR-related malpractice cases (both monetary and human) is expected to be much higher than reported and will likely continue to grow as health data becomes increasingly available to allow patients (and their lawyers) to understand how their care was delivered.
While the health care industry continues to find ways to improve clinical decision support and EHR usability, a major contributing factor to patient harm remains on the frontier of semantic interoperability – the exchange and the interpretation of health information, often at the terminology level. This is the challenge that Solor, a Department of Veteran Affairs (VA) initiated and award-winning project, seeks to tackle through an open-source ecosystem that will allow health care providers to preserve the meaning of health data when exchanged between systems so that the data remains accurate, shareable, and re-usable.
In 2015, only 6% of physicians could share patient data with other clinicians who used an EHR system different from their own. As different types of data are captured across the patient journey (e.g., symptoms, lab results, prescriptions) using different terminologies (e.g., SNOMED, LOINC, RxNorm), the exchange of this information requires a manual mapping process. The goal of mapping is to transform content between a source and a target system to meet the purpose of the integration. However, different informaticists often interpret the same data in different ways, which makes current mapping practices time consuming, error-prone, and a risk to patient safety.
Solor aims to address the patient safety risk caused by mapping through its interoperability framework to help connect different terminologies in one integrated platform, which adapts and evolves as clinical knowledge continues to grow. As more Veterans gain access to community care providers through the VA MISSION Act, the need for a foundational framework to define how health data should be shared becomes ever more important. Even though products from several EHR vendors are currently used by public and private health care organizations, they are heavily dependent on manual mapping processes whenever data is exchanged between systems. In order for EHRs to fulfill the promise of greater health care interoperability and patient safety, a product like Solor is needed to establish a common foundation so EHR data does not have to go through a risky exchange and transformation process. For more information about how Solor works differently from mapping, please continue reading here.
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