Electronic Health Records (EHRs) are a cornerstone of modern healthcare. They are necessary yet expensive investments. And because of their hefty price tag, EHRs tend to over-promise on key functionality and value. Now, they’re promising they can meet upcoming interoperability standards by communicating with FHIR. But can they really, or do they need some extra help? 

To keep up with the rapidly changing digital health transformation, your EHR needs to adapt —not only to new rules and regulations but also to the innovations your patients and clinicians demand. Every EHR vendor would like you to think an EHR can do this on its own. But the truth is, most EHRs need a data wingman to help them out. 

A (very) Brief History of EHRs

First appearing in the 1960s, EHRs were initially built to improve medical billing and to replace paper records. The EHRs now used by the largest share of US hospitals and physician practices were built in 1979. Other EHR vendors have come and gone, with some providers even developing their own systems. Yet shifting from paper records to electronic medical records remained slow. It took a series of federal incentives, including the HITECH Act in 2009 and subsequent objectives set by CMS, to achieve a 95% EHR adoption rate in hospitals by 2020. The hope was that more widespread use of EHRs would reduce healthcare costs and prevent medical mistakes.

EHRs Today: Good at the business of healthcare, bad at the delivery of healthcare

Today's EHRs cost health systems millions, even billions, of dollars to implement. With such hefty price tags, the expectations of their capabilities run high. They promise a wide range of benefits: from reducing physician burnout, costs and paperwork, to improving care, meeting regulations and integrating with new technologies.

While primarily designed to manage the business of healthcare (such as coding and billing), EHRs are also capable of holding data and presenting it to the clinician during patient visits. In theory, EHRs should have made a doctor’s job easier by eliminating the burden of paperwork. Instead, EHRs have shifted most of it to an online process adding to the clinician’s workload. Physicians now blame EHRs for stealing their attention away from patients and for adding hours of data entry and mouse clicks to their already long days. And the projected cost savings per patient are yet to be completely realized.

The Problem of Locked Healthcare Data 

As if the Herculean challenge of collecting, managing and serving up just patients' clinical health records wasn't enough, EHRs must now ingest even more data from myriad sources. Remember, most EHRs are built on software that predates putting the man on the moon. Their legacy architecture has lost its flexibility and agility. They weren't designed for modern healthcare, which now incorporates data from fitness watches, diet and exercise apps, mindfulness apps, telehealth and other wearable devices that are collecting all kinds of data 24/7/365. And this data needs to move: from a patient's watch to their provider, from the provider to the health plan, from the health plan to the researcher studying population health trends and disease function.

But if the data is trapped in EHR silos, the story that data could tell is on mute, rendering it useless.

Integration with FHIR Unlocks Data

How can data get its voice back? By ensuring it is interoperable and fully integrated. Integration and interoperability unlock this data, making each of these data-rich technologies and services more meaningful to the patient, provider and payer alike.

When reflecting on the objectives of the HITECH Act that pushed patient records to digitization, Seema Verma, former chief of the Centers for Medicare & Medicaid Services (CMS), said, "We didn't think about how all these systems would connect with one another. That was the real missing piece."

That missing piece—the key to unlocking the data and connecting all of the EHR systems together—is FHIR, Fast Healthcare Interoperability Resources. US Payers are already strongly encouraged to standardize their data using FHIR. It's only a matter of time before providers will need to do the same. That’s why we say the future is FHIR.

EHR vendors know they must adapt to the FHIR world to survive and are doing what they can to "set themselves on FHIR." EHR vendors create their own interoperability methods and can often build out custom integrations as needed. They typically use between 19-22% of FHIR standards. But at their core, EHRs are not standards-based; they are constrained by the purpose and history of their architecture, which makes them "FHIR wannabes."

Challenges EHRs Face as FHIR Wannabes

1. Interoperability is limited. EHRs speak their own language and weren't designed to communicate with outside systems. They're incapable of offering true, real-time data exchange because they use less than 25% of FHIR standards. Information that needs to be available for Integrated Delivery Networks (IDN) is locked in the EHR and not free-flowing
2. Integration is challenging and expensive. Most EHRs will build out custom integrations, but each integration takes weeks and costs hundreds of thousands of dollars.
3. Innovation is slow. Legacy EHRs were designed to deal with paper problems, they weren't designed for what's possible now. As a result EHRs become the bottleneck or constraint to the right information being available at the point of clinical or administrative decision making.  As a result innovation is slowed to the speed of EHR evolution rather than at the speed needed by the healthcare system.
   
   

Unleash the Giant Inside Your EHR

In a world on FHIR your EHR will only get you so far. Limited by their API, EHRs struggle with processing data: bringing it in from other sources, as well as adequately structuring incoming and easily sharing data. While EHRs contain a wealth of information, they struggle with applying it in real time. 

Think of EHRs like introverted folks who need some help joining the healthcare data exchange party. They have a lot of insights, but lack the skills or experience to join the conversation. Spending extra money on a new suit, in this case creating new integrations for the latest health apps, is an expensive and temporary solution. It doesn't address the underlying issues or new ones like compliance with any future health data portability rules.

What an EHR needs is a “wingman” in the form of a FHIR add-on. This addition can help the EHRs come out of their shell by drawing out their valuable data, introducing them to new connections, and translating the data to interested parties. A FHIR add-on will help you get more value from the wealth of data within your EHR. 

You Have Many Reasons to Smile

Providers who want to remain competitive and utilize the new health tech—and just as importantly, who want to prepare strategically for upcoming rules from CMS and ONC—must make seamless integration and interoperability their goal. You only need to implement a purpose-built, standards-based solution like Smile Digital Health one time to reap its benefits:

1. Interoperability: Your system will be able to integrate and exchange data between FHIR based and non-FHIR based systems. This will be particularly efficient with the payers' systems, which are already using FHIR. You'll also be prepared for any upcoming rules about interoperability and data exchange that require FHIR APIs.
2. Integration: Enjoy near-immediate integration so you can access the innovative digital health tech that is being built every day.
3. Innovation: Access and use your data on your terms in less time and for less cost. Improve your clinicians' experiences and enable better health care for more people.

Most systems only work with 25% of FHIR. Set yourself apart from competition and tap into the full 100% by using a true FHIR data management and exchange platform. The only one that uses 100% of FHIR standards 100% of the time.