Electronic Health Records

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Understanding Interoperability, Value of Health IT Standards

By Kyle Murphy, PhD

Defining interoperability in healthcare represents an important first step in the understanding the challenges ahead for those working to enable interoperable EHR and health IT systems and services.

Back in 2013, the leadership of the Healthcare Information and Management Systems Society (HIMSS) ultimately approved a definition of interoperability as "the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities."

Beneficiaries of the data exchange include clinicians, hospitals, pharmacies, laboratories, and patients. However, the definition does not end there. As the HIMSS Board noted on April 5, 2013, health IT interoperability occurs at three levels.

The first is foundational which "allows data exchange from one information technology system to be received by another and does not require the ability for the receiving information technology system to interpret the data."

At the second level is structural interoperability which specifies the format that data exchange must take so that it can move uniformly between health IT systems "another such that the clinical or operational purpose and meaning of the data is preserved and unaltered."

The third and final level identified by the HIMSS Board is what's known as true interoperability wherein both the sender and receiver of health information can use the information seamlessly:

Semantic interoperability takes advantage of both the structuring of the data exchange and the codification of the data including vocabulary so that the receiving information technology systems can interpret the data. This level of interoperability supports the electronic exchange of patient summary information among caregivers and other authorized parties via potentially disparate electronic health record (EHR) systems and other systems to improve quality, safety, efficiency, and efficacy of healthcare delivery.

Currently, a lack of interoperability has required the use of custom electronic interfaces between systems. As the Health Resources and Services Administration (HRSA) notes, these one-off solutions are costly and have prompted healthcare organizations and providers to make use of health information exchanges (HIEs) to facilitate at the most basic level the viewing of patient health data in a centralized location.

In the first draft of its interoperability roadmap, the Office of the National Coordinator for Health Information Technology (ONC) describes the present-day state of interoperability across the country.

"Electronic health information is not sufficiently structured or standardized and as a result is not fully computable when it is accessed or received. That is, a receiver’s system cannot entirely process, parse and/or present data for the user in meaningful and useable ways," the authors state.

The lack of interoperability is compounded by the absence of incentives available to promote robust data exchange and abundance of interpretations of existing rules and regulations for health information sharing.

To address the situation, the ONC has identified four high-priority areas its plan will address in the near term, specifically the need to:

establish coordinated governance framework and process for nationwide health information interoperability;

improve technical standards and implementation guidance for sharing and using a common clinical data set;

advance incentives for sharing health information according to common technical standards, starting with a common clinical data set;

clarify privacy and security requirements that enable interoperability.

At its core, interoperability is not possible without standards and specifications. As the Centers for Disease Control and Prevention (CDC) reveals in its discussion of the Public Health Information Network (PHIN), making standards and specifications confirm to federal law and regulation is a significant challenge. Among others, the federal agency collaborates with Health Level Seven International (HL7) and Integrating the Healthcare Enterprise (IHE) to develop standards for electronic data exchange.

Similarly, the Centers for Medicare & Medicaid Services (CMS) continues to work in concert with the ONC to incentivize the exchange of health information through the EHR Incentive Programs. Meaningful use requirements require the use of certified EHR technology (CEHRT) based on standards and certification criteria set by the ONC. That being said, the earliest requirements for HIE, beginning with Stage 2 Meaningful Use, are limited to transitions of care and public health reporting.

In the context of healthcare, interoperability is its infancy and the decisions currently being made by industry stakeholders will determine when it reaches its full maturity.




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