- The varying interpretation of health IT standards and specifications has contributed to a lack of health IT interoperability, but its effect on health data exchange may pale in comparison to how different definitions of open EHR technology has prevented the fluidity of health data between providers and patients.
While the current dialogue about interoperability in healthcare focuses on roadmaps, governance, and infrastructure, it would benefit from taking a step back.
"We decided we needed to write a definition of what an open EHR was," University of Texas Health School of Biomedical Informatics Professor Dean F. Sittig, PhD, tells HealthITInteroperability.com. "When we started thinking about that definition, it turns out that, as with many aspects of electronic health records, it depends on whether the system is working well or not working well."
Currently, Sittig is championing five use cases for open EHR technology and health IT interoperability under the moniker of EXTREME:
• EXtract: extract patient records while maintaining granularity of structured data
• TRansmit: authorized users transmit patient records to other clinicians without losing structured data
• Exchange: exchange enables organizations to participate in HIEs regardless of which EHR they use
• Move: move enables organizations to switch EHRs without incurring extraordinary data extraction and conversion costs
• Embed: embed enables organizations to develop new EHR features of functionality and incorporate it into clinicians’ workflow
According to Sittig, a person's perspective (or perspective) is a major influence in determining his vision of health IT interoperability.
"If you think about it from the patient's standpoint, interoperability means one thing," he continues. "And in some sense, clinicians would like copies of your records from every other doctor that you've ever seen, but in another sense, it's not clear they would really like that because then they'd be responsible for it."
In fact, given the pressure to implement and adopt EHR technology for the EHR Incentive Programs, physician EHR users could have added reasons for wanting their clinical data to move from one system to the next, which could be their EHR replacement.
"A clinician might like to switch EHRs, for example," Sittig explains. "They bought an EHR at the beginning of meaningful use and it's not working out very well and they want to buy another EHR, but they've got two years of records in their current EHR and they want to move all those records from the current EHR to their new EHR."
The problem with many attempts at advancing health IT interoperability is insufficient use cases, claims Sittig.
"The people demanding interoperability usually have one use case in mind that their definition of interoperability solves that use case, and I don't think they've thought through all the other stakeholders that are involved and the ramifications of what they're asking for," he maintains.
The creation of EXTREME is intended to expand the scope of interoperability in healthcare and identify the barriers in the way of an interoperable health IT infrastructure, such as policies and procedures that prohibit health data exchange which are not technical in nature:
Vendors could easily build stuff that was interoperable, and whenever they decided that they wanted to, they have, and so there's a lot healthcare organizations that don't really want to share any data because the people they're sharing data with are their competitors, and sharing data would mean they would lose either revenue or patients or something like that. And so it's easy for healthcare providers to blame vendors.
Another obstacle dates back to the 1990s and a key feature left out of the Health Insurance Portability and Accountability Act of 1996, Sittig argues.
"Right now, we have a lot of rules and regulations in our society that are prohibiting this," he states. "The federal government complains about interoperability, but they're the ones that have made the single most important rule that's stopping interoperability, and that's the fact that we don't have a unique patient identifier for all patients in the United States."
The use cases identified by Sittig are likely to prove challenging, but they certainly address limitations in current thinking health IT interoperability.