Since the data and the methods of collection are similar or identical in the two processes, many assume that integration would be straightforward. However, few are familiar with the intricacies of both worlds, leading to simplified assumptions as well as schemas and timelines for integration that are very ambitious or unrealistic.
This paper will discuss some of the key obstacles in bringing EHR and EDC together, and will evaluate some of the proposed architectures for implementing an integration of the two.Electronic health records
The EHR is much more common in European and other non-U.S. countries. In fact, physicians in countries such as Sweden and the Netherlands use the EHR for more than 80% of patient encounters.1 The lagging implementation of EHR in the United States is not because of a lack of available technology. The United States is hampered by a fragmented private health care system, where no central authority can dictate a single solution.
Furthermore, there are a plethora of potential solutions and vendors from which each autonomous practice or health care network can choose. A large institution may implement several different EHR systems, each for a different component of their need. Countries with governmentally managed health care systems, however, can require the use of particular EHR systems and can even dictate the common data dictionary and database structure to be used—allowing for a much more organized sharing of data within the system.
Of the hundreds of vendors of EHR systems, dozens have significant sales in various segments of the EHR market (hospitals, large group practices, health maintenance organizations, and small practices). In large hospital systems, a handful of dominant vendors have emerged. Recently, consolidation is beginning to create vendors whose solutions operate in several different practice settings.
Although some of the systems are relatively modern, it is very common for commercial EHR systems to be built on older, specialized software languages for systems originating in the era of mainframe computers and minicomputers. These EHR systems may not incorporate modern information technology, including Web interfaces, the use of XML, or concepts such as Web services. Unfortunately, much of the interoperability between EHR systems and the potential for EHR/EDC integration would require the use of such tools.