Living the digital dream in a hybrid world

All clinical data impacts decisions made by clinicians. Information in one place, at the point of care is core to patient wellbeing. Data sitting outside of the Electronic Medical Record (EMR) leads to the potential for errors that might ultimately prove fatal to the patient.

On the pathway to the Nirvana of Hospital Electronic Health Records, the care administered outside of hospitals isn’t always incorporated. Indeed, the bulk of a person’s health and illness data resides within non-hospital systems (GP’s, Specialists, pharmacy, aged care and so many more).

Even within the boundaries of tertiary care, digital systems do not cover 100% of clinical communications, activities, and actions. Whilst public hospital Electronic Medical Record (EMR) rollouts are progressing across Australia, the implementation across each state and territory is far from paperless.

Whilst we are achieving greater levels of interoperability between EMR’s via Integrating the Healthcare Enterprise (IHE) initiatives, this assumes that all providers of care use digital records and, if they exist, that those systems are able to or prepared to share patient information electronically.

Even in organisations that declare themselves to be digitised, a good deal of information remains on paper. This ranges from results that have written annotations, through to specialties that still use paper records as well as the EMR down to organisations that are paper lite.

Regardless of the differing levels of interoperability, and despite the obvious advantages of systems that can communicate with shared meaning, as the majority of a person’s clinical data resides within non-hospital systems, it’s crucial that we incorporate all valid sources of information or updates to current data for readiness at the point of care.

In Australia, EMR implementations have been in progress for the better part of 30 years. Regardless, not all hospitals or primary care practices with EMR’s systems are completely digital. Whilst public hospital EMR rollouts are progressing at varying rates across Australia (EMRs are used by approximately 65 per cent of Australia’s public hospitals) the implementation across each state and territory is far from paperless. In the private sector, adoption is yet to gain the traction evident in public health. Internationally, we are seeing similar trends.

Still, despite the apparent digitisation of health, healthcare providers still demand paper records. In 2021, the Australian Digital Health Agency announced the Australian health information gateway. A plan to create an electronic data exchange across all venues of care. The benefits of such a system are obvious.

Nevertheless, the challenge is clear. How do you link national records when?

• There is no national guideline for electronic health records
• Not all clinical data is digital
• Crosses geographical boundaries
• Information is in multiple languages
• Not all systems (paper or digital) share a common vocabulary
• The ability to link other information exchange technologies between states and territories is not guaranteed
• Health data isn’t exclusive to hospitals
• Currently, no organisation operates without the use of paper for clinical or administrative data
   

Given the hybrid nature of healthcare data collection and retention, and acknowledging that a single source of information is the safest and most efficient option, how do you as a clinician, healthcare professional or informatician ensure your patient record is as complete as possible?

This discourse isn’t intended to be a criticism of EMR implementations. A complete digital record has demonstrated benefits to patient care and clinical communication. Still, given that the sharing of clinical information is often incomplete, and that semantic interoperability is possibly even further behind, how do we deal with the patient who presents to your ED with a handful of paper?

For further information on Lexmark Healthcare and their solutions for hybrid to digital records, please contact Melanie Ford — melanie.ford@lexmark.com

Healthcare | Lexmark Australia

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