This week I'm in Osaka keynoting the IEEE Engineering in Medicine and Biology Society annual meeting.Dr. Hiroyuki Yoshihara, my colleague from Kyoto University, hosted a pre-conference workshop on the state of EHRs throughout the world. For years I've said that the challenges of EHR adoption and healthcare information exchange are the same in every country. This workshop confirmed my impressions. Speakers from Japan, New Zealand, and Brazil each spoke about issues such as:
Do we centralize data from multiple EHRs into a single repository for care coordination, patient engagement, and research? Or do we create federated options with just in time data sharing from distributed EHRs? The answer is that every locality approaches the problem based on requirements and policy concerns. There is no one right answer. Care coordination works well with distributed approaches (pushing summaries, pulling summaries, viewing external records) but analytics for population health and quality measurement benefit from data aggregation and normalization.
Do we accelerate change via top down government programs or bottom up industry driven initiatives? The consensus was that top down, standardized, regulated approaches may temporarily slow innovation but they are effective in promulgating widespread adoption. In the US, we've tripled adoption of EHRs since HITECH.
Do we issue a national patient identifier (required or voluntary) to improve the accuracy of healthcare data aggregation? Every country has different policy concerns and varying cultural tolerance of government mandated programs. However, there was widespread agreement that an identifier for healthcare, required or voluntary, would make healthcare information exchange and analytics easier. A curated national provider directory is also desirable.
How do we ensure data is comparable across multiple EHR systems? Should we adopt detailed clinical models such as the work of the CIMI effort? There was widespread agreement that vocabularies and clinical models are foundational to semantic interoperability and data aggregation.
Finally, how do we protect privacy? Issues of consent, metadata, and de-identification are important throughout the world and approaches are highly variable based on culture, privacy laws, and regulations. There is no single right answer but all agree that patient mediated exchange in which the patient is steward of their own information addresses many of the concerns.
My keynote today will focus on the grand challenges facing all engineers, informaticians, and policymaking professionals. The five topics above - ubiquitous healthcare information exchange, universal adoption of standardized EHRs, accurately identifying patients/providers, creating foundational semantic interoperability tools, and protecting privacy are important worldwide and I look forward to solving them in our generation.
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