EHR redesign required to better integrate research, practice

The clinical informatics community must be involved in a redesign of electronic health record systems to encourage data-sharing between healthcare research and clinical practices, writes Keith Marsolo of the biomedical informatics division of Cincinnati Children's Hospital Medical Center in an article published this week in the Journal of the American Informatics Association.

Marsolo cites frustrating examples in which EHRs make it difficult or impossible to use clinical data in research or vice versa. Current systems that in effect offer just an electronic version of a paper chart create "walled gardens" of information that further the disconnect between analyzing information collected and instituting improvements at the point of care, he says. Marsolo calls for a lobbying of EHR vendors to open their systems and design new architectures that allow for the integration of external applications and services.

Too much time is required now to create workarounds to EHR systems' limitations, he says, and without dedicated EHR staff, research projects must compete for other projects for priority, including the conversion to ICD-10 and Meaningful Use initiatives.

"It is time for research and operations to become more integrated," Marsolo says. "If we are to ever achieve the vision of a learning health system, where learning occurs with every patient encounter, we need to ensure that the clinical information systems are configured to allow this learning. … Expectations must be set [for EHR staff] that their role is not only to support clinical care, but also quality improvement and research. In a learning health system, all three occur in every single encounter and cannot be separated."

Users must be able to create new data-collection forms and other interfaces that fit easily into clinical workflow, he says. And it must become easier to extract information from these forms through common application programming interfaces (APIs).

Marsolo calls on EHR vendors to publish their APIs and to standardize them across the industry to simplify integration of external applications and services. While he doesn't foresee an open marketplace such as that in the Android ecosystem, he favors the Apple model in which outside developers submit applications for approval for use with its products.

The informatics community, he says, has much to contribute to improving EHR design, particularly in clinical decision support, care process redesign, and workflow analysis/optimization.

The government's push toward digitization has come under renewed criticism, including in a Wall Street Journal opinion piece that calls its benefits "hype." But as FierceEMR's Marla Durben Hirsch recently pointed out, the systems are woefully lacking in standards, meaning there's no consistency in hardware or software, something an Institute of Medicine report has said must be addressed.  

Without that standardization, more work will fall to researchers to parse out when that EHR data is unreliable.

To learn more:
- read the JAMIA article