- Improving interoperability is the central focus of several CMS federal incentive program policies, ONC initiatives, and new partnerships between EHR vendors and health data exchange services providers.
Healthcare’s inability to achieve the level of seamless information exchange now common among other industries — such as banking — frustrates healthcare stakeholders across the industry. In a September 2018 survey, nearly 40 percent of physicians cited the current lack of interoperability in healthcare as a primary source of dissatisfaction.
While there is no silver bullet that will solve the interoperability problem overnight, there are steps healthcare organizations can take to improve their ability to exchange patient health information with outside hospitals, health systems, and providers.
A recent publication from the National Academy of Medicine (NAM) urged healthcare organizations to prioritize interoperability during the selection process to spur organizational improvements that may also ripple out to affect the industry as a whole.
Basing EHR selection decisions partly off of interoperability needs is one way healthcare organizations can improve their own ability to exchange data, while also increasing market pressure on EHR vendors to boost the data exchange capabilities of their products.
But what kinds of interoperability questions should healthcare organization leadership ask before signing the bottom line on a new EHR contract?
Does the EHR vendor adhere to industry standards?
Ensuring an EHR vendor adheres to widely-accepted health data standards can boost a healthcare organization’s ability to engage in health data exchange with outside health systems using different vendor technologies.
To determine whether a certain system meets industry standards, healthcare organizations can look to online resources provided by federal regulators.
ONC publishes updated information about the percent of EHR vendors offering 2015 Edition certified EHR technology (CEHRT) in online data visualizations. These data visualizations also show which vendors meet all criteria to fulfill the Base EHR definition, and which vendors only meet a percentage of criteria.
EHR vendors that meet all certification criteria to fulfill the 2015 Edition Base EHR definition must facilitate health data exchange and access through enhanced data export capabilities and include functionality that supports transitions of care.
Additionally, products that fulfill this definition must allow for third parties to connect to health IT products through application programming interfaces (APIs).
As of October 2018, Cerner, Epic, Allscripts, Greenway Health, eClinicalWorks, GE Healthcare, and Medsphere Systems meet 100 percent of the 2015 Edition Base criteria.
This month, ONC also published information about which EHR vendors use the Fast Healthcare Interoperability Resources (FHIR) data standard to meet 2015 Edition CEHRT requirements. Currently, nearly a third of EHR vendors use FHIR.
With FHIR adoption and implementation on the rise, choosing an EHR vendor that leverages the internet-based data standard may become increasingly important to healthcare organizations hoping to exchange discrete data elements.
Allscripts, athenahealth, CPSI, Cerner, eClinicalWorks, Epic, MEDITECH, and GE Healthcare are among the vendors currently offering health IT products that leverage FHIR.
These resources can help healthcare organizations make better-informed purchasing decisions.
Assessing whether an EHR vendor’s product offering meets industry data standards, interoperability standards, and certification requirements may help healthcare organizations identify the system best suited to their needs.
Does the EHR vendor work with interoperability services providers?
Industry alliances and initiatives centered on promoting interoperability, standardization, and stakeholder collaboration have been integral to increasing health data exchange between healthcare organizations.
Selecting an EHR vendor that is a Carequality Interoperability Framework implementer or a member of the CommonWell Health Alliance gives providers the opportunity to engage tools that enable streamlined health data exchange with other Carequality or CommonWell users.
Currently, the Carequality network includes more than half of providers nationwide, while CommonWell is in use by several of the most popular EHR vendors, including Allscripts and Cerner.
Choosing an EHR vendor with a track record of partnering with interoperability services providers may be a plus for organizations looking for more advanced health data exchange capabilities, as CommonWell and Carequality continue to develop and launch new initiatives.
CommonWell leverages FHIR to facilitate targeted health data exchange between providers.
“Our model is relatively unique,” CommonWell Executive Director Jitin Asnaani told EHRIntelligence.com. “We take a C-CDA and only look at one element.”
CommonWell also utilizes a cloud-based approach to establishing connections between member organizations.
“On an interoperability side, it’s a no-brainer,” said Asnaani. “You have go to cloud-based interoperability. You’re going to be building more connections over time. You’re going to be doing more with that data over time.”
Integrating the newest data standards and infrastructure types is part of CommonWell’s goal to constantly innovate to meet the needs of the evolving health IT landscape.
“There will always be a new wave of interoperability,” Asnaani said. “There is a migration that has to happen now, and at the end of it we’ll say, what about the next migration? And then there will be another migration later.”
Similarly, Carequality is updating its governance model to support FHIR.
Carequality and CommonWell are also in the process of launching a joint CommonWell-Carequality connection to enable bidirectional health data exchange between members of the CommonWell network and implementers of the Carequality framework.
Greenway and Cerner are currently participating in the pilot project. The connection will eventually be made available to all CommonWell members.
Choosing an EHR vendor that engages with interoperability services providers can help healthcare organizations gain access to enhanced data exchange capabilities and more easily connect to different hospitals and health systems across the country.
Does the EHR product’s level of interoperability align with organizational needs?
Finally, assessing whether an EHR product offering’s interoperability capabilities align with the specific needs of patients and providers can help to guide EHR selection decisions.
In a special report, NAM recommended healthcare organizations develop interoperability specifications for inclusion in requests for proposals (RFPs) during health IT purchasing processes.
“The ONC Interoperability Standards Advisory provides some useful resources, including best practice guidance on data exchange standards, production of security and patient privacy, implementation guides, and integration profiles as well as guidance on contracting with EHR vendors,” experts suggested.
When drafting an RFP, healthcare organizations can convene key internal stakeholders to identify top user needs related to interoperability.
“Once user needs are defined, the next layer of technical requirements should be derived from those user needs,” wrote NAM. “Requirements may include functional requirements, including interoperability, and other operational requirements or constraints such as timeliness and accuracy.”
In addition to identifying user needs, healthcare organizations may also want to account for organizational resources.
Leadership can assess the organization’s realistic capacity to invest staff, capital, and time on purchasing, implementing, and training users to engage interoperability solutions in order to identify the best EHR system for the environment.
By carefully weighing each vendor’s interoperability offerings alongside organizational needs and resources, healthcare organizations can make well-informed EHR purchasing decisions.