UTDKS

Cwoodru5, I think you started this thread bringing up valid points. The best explanation to why standards are needed in interoperability is like the example given in the book about railroads staying on track (Sewell, 2013). Sewell and Thede (2013) also point out how when deviations from these standards happen it has a rippling effect on updating and maintaining data, integrate applications, and aggregate information between systems (pg. 357). Reference: Sewell, J., & Thede, L.Q. (2013) Informatics and nursing: Opportunities and challenges. (4th ed.). Philadelphia: Lippincott.

Aedward18 brings up a good point. As the saying goes, there are too many hands in the cookie jar. It would be easier to have one organization set the standards than 30+ organizations. There are multiple vendors available for hospitals to purchase their EMR from. Sewel and Thede (2013) state how "purchasing from a single vendor does not insure the buyer that the system is seamlessly interoperable; large well-known vendors commonly purchase smaller popular applications then design interfaces with other vender applications" (pg. 357). As a result, medical personnel are documenting the information in multiple areas, which leaves the opportunity for mistakes and more time finding what is actually going on with patients. Resources Sewell, J. P., & Thede, L. Q. (2013). Electronic healthcare system issues. In Informatics and nursing: Opportunities and challenges (4th ed., p. 357). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

As stated in previous posts, standards are needed to organize communication between medical disciplines a.k.a interoperability. By using EMR in clinicals, we have seen how interoperability is an abstract idea, but fine-tuned in practice because of standards. The most note worthy standard used in the EMRs at clinicals is the use of wb/s. Nurses on the floor did not know what it meant until the floor director stated it means "with breakfast and supper." Supper is a geographical term used in the south, but not so much in other areas of U.S.A. Policies need to be clearly defined to clear up the areas of miscommunication. If medical personnel do not know what a simple, "wb/s" means, then how are we holding them responsible to other standards that may or may not be clearly explained? Furthermore, interoperability would be chaos without standards in this growing and ever-changing healthcare system we have. People doctor shop, travel, or move to different states. EHRs have been seen as a solution to this problem. Policies guide this solution from spiraling out of control. "Health system usability, computer skills and the system's fit within the organizational culture and processes are significant factors in implementation success" (Ludwick, D. & Doucette, J., 2009). In Italy, the Lombardy Region underwent standardization to enhance interoperability of their own electronic health records. The region had two options: completely change the current hospital information system to a new "Regional system" or maintain the current information system at the department/hospital level with the addition of a middleware software that would integrate standard requirements (Barbarito et al., 2012). The region chose the second option and it is still in use. Without standards in place, the Lombardy Region would not be able to organize "4,700,000 pharmacological e-prescriptions, 1,700,000 e-prescriptions for laboratory exams per month...490,000 laboratory medical reports, 180,000 radiology medical reports, 180,000 first aid medical reports, and 58,000 discharge summaries [per month]" (Barbarito et al., 2012). References Barbarito, F., Pinciroli, F., Mason, J., Marceglia, S., Mazzola, L., & Bonacina, S. (2012). "Implementing standards for the interoperability among healthcare providers in the public regionalized Healthcare Information System of the Lombardy Region." Journal of Biomedical Informatics, 45(4), 736-745. Retrieved , from http://0-www.sciencedirect.com.opac.uthsc.edu/science/article/pii/S153204641200007X Ludwick, D. and Doucette, J. (2009) "Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries." International Journal of Medical Informatics. 78(1), 22-31. Retrieved from http://0-www.sciencedirect.com.opac.uthsc.edu/science/article/pii/S1386505608000920>.