EHR interoperability: Fix the potholes or find a new path?

The lack of interoperability among electronic health records, no doubt, is a major impediment to improved healthcare and lower costs.

But now we have a much more granular understanding of why the industry is having so much trouble achieving it.

First we have a new study published in the Journal of the American Medical Informatics Association (JAMIA), which reveals that the Consolidated Clinical Document Architecture (C-CDA) for document exchange is chock full of "trouble spots" such as errors, omissions, and variability that are impeding data exchange. Some of the barriers to interoperability could only be found by manually digging through the data and require manual data reconciliation during exchange.   

That's pretty bad. But what's worse is that EHRs must produce C-CDA documents, which is a library of templates to transmit patient data, to meet Stage 2 of Meaningful Use.  The study's researchers themselves warned that any expectation that C-CDA documents could be relied on was "premature." Sounds like C-CDA wasn't ready for prime time. 

Then we've got the announcement that a pilot test program to share behavioral health information was successful. The announcement, from the Office of the National Coordinator for Health IT and the Substance Abuse and Mental Health Services Administration, was upbeat. 

But buried in the actual report was an acknowledgment that the biggest barriers to sharing this data are the federal and state laws that set up roadblocks to interoperability in order to protect the confidentiality of this sensitive patient information. As a result, this data is typically not even included in health information exchanges.   

There are a lot of reasons for the lack of EHR interoperability, of course. Vendors have benefited from offering only proprietary, closed systems. Health information exchanges are still going through growing pains. Some providers don't want to pay to play. Many patients are leery of allowing their data to be shared with HIEs and won't allow some or all of their information to be part of them.  

The road to interoperability is full of potholes. Does the industry remain on this bumpy road, filled with barricades, or is there a smoother road to take?

Last month, ONC released its 10-year plan to develop interoperability. The plan includes a lot of the current buzz phrases, like "scaling trust," "patient matching" and "work to further standardize vocabulary." The agency invites stakeholders to join ONC in figuring out how to proceed. It sounds laudable.

But is the plan sort of backward? Why wasn't standardization created first? What do we do about well meaning laws that hamper data exchange in the name of patient privacy? And how will patient matching work without some unique patient identification number?

Regarding the C-CDA, was its inadequacy known ahead of time? Was there sufficient testing before C-CDA was chosen for Stage 2? Does this mean that providers participating in the Meaningful Use program are destined to fail because data exchange is fundamentally flawed?

The researchers involved in the JAMIA study warned that without "timely policy" to make needed changes, "semantically robust document exchange will not happen anytime soon." ONC has for years shied away from health information exchange regulation, and even now are taking a collaborative approach.

But it may need to make a decision was to whether the current road is the correct one. - Marla (@MarlaHirsch and @FierceHealthIT)

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