For every digital health company that produces clinically relevant data, the inevitable question at sales meetings is: “Can you integrate with our EHR system?” But the better question is not can we integrate, but should we?
The core domain of the EHR is to house the legal health record (LHR) in an electronic format. When it comes to data integration from other systems, they come up short. Digital health companies are pressured by clinical customers to “integrate” with the EHR. API relief via FHIR and Meaningful Use Stage 3 may come. But for now, discrete data integration remains a costly and time-consuming endeavor that may not be worth the trouble. The assumption is that customers need data exchange, when in fact what providers largely want is clinical workflow integration to deliver meaningful insights that are actionable at the right time.
A 2013 Patient-Centered Outcomes Research Institute (PCORI) workshop identified two types of EHR integration: 1) full collection or discrete data integration or 2) systems collect, store, and report data independently, with summary information integrated into the EHR. The industry is now seeing more movement into option 2 with “wraparound” solutions that embed data visualization from the digital health platform that clinicians can then review. (Aaron Neinstein summarizes this well here.)
Here’s some key considerations for digital health companies as they choose between full data integration versus a “wraparound” solution:
Clinical workflow integration is different than data integration. Medical personnel are bombarded with technology, and the key step is to get data in front of providers so they can use it efficiently. This can come in the form of a strategically placed hyperlink within the EHR, a PDF report for clinician review, or a launch button that takes the user to your platform in an IFrame.
Location, location, location. Putting the access point to your data in the right place in the EHR is key. It should be flagged to draw attention to new or critical information. Additionally, preserving user and patient context when launching into your digital health platform is essential. Often digital health companies can pass provider user and patient context within a secure hyperlink.
Pull and push what you need, leave the rest. You may need to invest in a light integration to pull data from the EHR to run your solution, or to push data back in. Be thoughtful about this process. Do you really need the patient name? Does the clinician need every blood pressure logged, or just the range, or highest value?
Respect LHR requirements. According to the American Health Information Management Association, the legal health record is the documentation of services provided to a patient by a healthcare organization, such as immunizations, vital signs, notes and documentation. But data can exist outside the EHR in other databases, such as personal health records and devices. Providers can even interpret that data outside the record, they may just need to record the key data points, conclusions, and their level of effort in the interpretation.
HIPAA still applies. Just because the data may not all go into the EHR, digital health companies should follow best practices regarding the storage and auditing release of protected health information. If the data include key identifiers, the use is likely subject to all HIPAA provisions. Furthermore, according to the U.S. Department of Health and Human Services, any contract will require these protections.
You don’t need it all to bill. Of course, this depends on local and federal guidelines and the type of information collected. But in general, professional billing requirements are met by summarizing the data, the clinician’s interpretation, how it impacted decision-making, and the time spent. Rows and rows of discrete data are not required and may in fact make it harder to read.
Soon clinical care will be guided less by static notes and more by real-time data. As we look ahead to more and more data coming in from multiple channels, we need to get smarter about data visualization and interpretation rather than spending weeks buried in HL7 protocols, API libraries, and custom EHR reporting. Looking beyond the confines of restrictive vendor-based EHRs, the primary goal should be an aggregate view of digital health data to drive meaningful insights and subsequent key interventions.
Carolyn Bradner Jasik, MD is VP of Medical Outcomes at Mango Health and an Assistant Professor of Pediatrics at the University of California, San Francisco. Mango Health promotes patient engagement in healthcare through elegantly designed mobile applications and creative enterprise workflow integration.