Abstract
Digital health systems and innovative care delivery within these systems have great potential to improve national health care and positively impact the health outcomes of patients. However, currently, very few countries have systems that can implement digital interventions at scale. This is partly because of the lack of interoperable electronic health records (EHRs). It is difficult to make decisions for an individual or population when the data on that person or population are dispersed over multiple incompatible systems. This viewpoint paper has highlighted some key obstacles of current EHRs and some promising successes, with the goal of promoting EHR evolution and advocating for frameworks that develop digital health systems that serve populations—a critical goal as we move further into this data-rich century with an ever-increasing number of patients who live longer and depend on health care services where resources may already be strained. This paper aimed to analyze the evolution, obstacles, and current landscape of EHRs and identify fundamental areas of hindrance for interoperability. It also aimed to highlight countries where advances have been made and extract best practices from these examples. The obstacles to EHR interoperability are not easily solved, but improving the current situation in countries where a national policy is not in place will require a focused inquiry into solutions from various sources in the public and private sector. Effort must be made on a national scale to seek solutions for optimally interoperable EHRs beyond status quo solutions. A list of considerations for best practices is suggested.
Highlights
Digital health systems and innovative care delivery within these systems have great potential to improve national health care and positively impact the health outcomes of patients
electronic health records (EHRs) are the connective tissue of a health system; yet, most countries have systems that cannot unite the information of all their citizens because even within 1 city, the software used in 1 hospital is incompatible with that used in another, it may have been procured from the same company
Effort must be made to educate health care administrations on how EHRs work, why they can be considered as safe as banking data, and what cybersecurity checks are in place and emphasize the importance of a continually updated security plan
Summary
Digital health systems and innovative care delivery within these systems have great potential to improve national health care and positively impact the health outcomes of patients. Very few countries have systems that can implement digital interventions at scale This is, in part, because of the well-known lack of interoperable electronic health records (EHRs). We cannot explore or create these tools without aggregating and sharing patient data under a common set of (secure) standards Without interoperability, using these tools or implementing remote patient monitoring products is extremely complex or happens in small samples. Epic is by no means alone on the list of EHR companies that are faced with a more technically savvy client base who expect better interfaces and services, and they are trying to become more agile; in 2018, the company announced One Virtual System Worldwide, which allows providers to access patient information from other institutions [13], which is a notable step but perhaps not on par with the data integration and analysis capabilities of companies such as Google and Apple. Systems subject to a lack of efficiency cannot afford more time, and valuable analysis is lost because of poor information systems
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