Healthcare Innovation: How to Achieve EMR Interchange

EMR interchange has been a major goal of the tens of billions of dollars that have been spent to buy and install EMR's. The theory is that making it easy for the next medical provider you see to have access to your complete health record will improve health. It might! But the current methods for achieving integration are not working. Not. Working. It's easy to understand why they will NEVER work, and what can be done to achieve the same result.

Not to be mysterious about it, here's how: forget EMR interchange. It's not working because it's hard and none of the people who build and control EMR's really want it to work. Instead, enable a new generation of personal EMR's. It's literally hundreds of times easier.

My EMR vs. Integrated EMR's

Everything is great if I go to a single integrated hospital system that uses a single EMR. I go from place to place in the hospital complex, and everyone knows who I am, where I've been and what's going on:

No problem.

The problem happens when I go to an office, a clinic and a hospital. They each have EMR's. What all the "experts" think is best, backed by tens of billions of dollars, is for the systems to talk with each other. What I suggest instead is MyEMR app, which gets the latest information from each EMR and uploads everything to the next place I visit. Here's the choice:

They look pretty similar, right? There are three unique lines (data paths) connecting my EMR to each of the places I've visited, and there are three unique lines connecting each of the providers (H-C, H-O and C-O).

When the numbers grow, they start looking not quite so equivalent. Let's look at six distinct EMR's. With My EMR, there are just six possible connections:

But if the six have to interchange with each other, we're up to 15 possible connections.

Hmmm. Not a good trend. What about when the number gets bigger? What if 100 EMR's had to talk with each other? How many unique connections (data paths) would there be then? Here it is:

You may say there aren't that many vendors. But getting two different installations of EMR software from the same vendor to talk is still a lot of work! Not to mention the fact that there are many different versions, configurations and customizations of each piece of software. The real number is likely to be much larger!


Just installing an enterprise EMR tends to be an incredibly expensive, years-long disaster. There's a good reason based on simple arithmetic that many years and tens of billions of dollars have yet to achieve any meaningful amount of interchange between EMR's -- there's a combinatorial explosion. The same arithmetic strongly favors the personal EMR approach.

Incentives also favor the personal EMR as the center point of integration. How eager is one hospital CEO to make it real painless for patients to go to the competitor? Patients, on the other hand, are highly incented to want the data in their hands; not only would it save endless hours filling out paperwork and avoiding yet another history interview with its inevitable misinformation, but it's likely to help their providers avoid errors and keep them healthier. Of course, the vendors and systems have a death-grip on patient data, and really don't want to give it to patients, regardless of what they might say. But at least sending data to personal EMR's is a solvable problem without a combinatorial explosion of work to get it done.