Electronic Health Records

Adoption & Implementation News

What is the future of standards for EHR, interoperability?

By Kyle Murphy, PhD

Standards play a crucial role in enabling the interoperability of EHR and health IT systems and therefore the meaningful use of EHR systems. As the HIMSS13 Interoperability Showcase and announcement of collaborations and alliances among EHR developers demonstrated, the vendor community is preparing to make real inroads in enabling the seamless exchange of health information from one system to the next.

Despite the recognition that interoperability will depend on policymakers and developers working in conjunction, the challenge that remains is determining the standard or standards to be used in order achieve true EHR interoperability, a process which is fraught with many pitfalls as the experience of Integrating the Health Enterprise (IHE) has shown.

“I am a big believer in standards, and it’s all about harmonization of them and proper selection of them based on use cases — and that’s a process that IHE has pretty well accomplished,” Blair Butterfield, VitalHealth Software President, North America, told EHRintelligence.com in an interview at HIMSS13. “The problem is they haven’t moved fast enough in terms of developing enough profiles that serve all the specialties and their early origins as an IT-driven organization meant that they didn’t have enough clinical input in the early year, but they are trying to compensate now and pull more physicians in to the whole process.”

More recently, the Office of the National Coordinator for Health Information Technology (ONC) has taken up the challenge and thrown its support behind the HL7 Clinical Document Architecture (CDA) Continuity of Care Document (CCD), which has given EHR developers a means to approach interoperability.

“The thing that helps us here is ONC is trying to set some broad guidelines around this,” explains Butterfield. “They haven’t been prescriptive in my view compared to many other countries that I’ve worked with closely on this process where they are very prescriptive. On the other hand, they have avoided the mistakes that some of those countries have made in choosing the wrong standards and then having to re-architect.”

According to the VitalHealth President, whose team demonstrated its ability to interoperate with other systems as part of the Interoperability Showcase, the lack of interoperability comes down to identifying a viable transport mechanism rather than the right content:

The content is pretty well vetted out. They’ve got LOINC for labs, RxNorms for meds. They’ve got SNOMED. They’ve got all these structured, coded content things. The HL7 CDA is fairly well fleshed out. Where they’re falling short is on transport side. So they started with NHIN Direct, which is a very rudimentary, point-to-point — “I know you, I’m going to send you this file.” But do I know all the places this patient’s ever been and can I pull in standards-based records for all of those and integrate them seamlessly into my EMR without thinking about it and have it automatically homogenize all that data and standardize it all so I can see a trend line and a history? No. They’re not doing that yet.

While the technical side of interoperability lacks a proper transport mechanism, what is truly lacking currently in the pursuit of interoperability is the widespread acceptance and implementation of standards.

“It’s possible if you just intelligently use the standards and then you get buy-in through a vetting process and do real implementations,” says Butterfield. “So as that happens and those standards become implemented and proven, we’ll continue to see it grow. But it still has a long way to go.”

As anyone following the interoperability conundrum, there is no shortage of standards. In order for EHR and health IT systems to interoperate, the health IT industry must first achieve consensus on standards and then fully support their adoption.




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