EHRs need five 'use cases' to be interoperable

Electronic health records should have five "use cases" in order to be considered "open" or interoperable, according to a new article in the Journal of the American Medical Informatics Association (JAMIA).

Authors Dean Sittig, from the University Texas Memorial Hermann Center for Health Care Quality and Safety, and Adam Wright, from Boston's Brigham and Women's Hospital, state that five functionalities--to EXtract, TRansmit, Exchange, Move and Embed data (or "EXTREME" uses)--are important to move to EHRs more globally. The authors identify requirements for each use, such as infrastructure that can respond to queries 24-hours-a-day, seven days a week, the ability to preserve metadata when moving data and secure log in and role based access controls.

"Widespread access to 'open EHRs' that conform to at least the five EXTREME use cases we propose is necessary if we are to realize the enormous potential of an EHR-enabled healthcare system," Sittig and Wright say. "Healthcare delivery organizations should require these capabilities in their EHRs. EHR developers should commit to providing them. Healthcare organizations should commit to implementing and using them.

"In addition to having all EHRs meet these technical requirements, we must also begin addressing the myriad socio-legal barriers to widespread health information exchange that is required to transform the modern EHR-enabled health care delivery system," the authors add.

Sittig and Wright recommend that EHRs be subject to stringent testing to ensure that receiving systems can import, parse and store the data. They also question some of the constraints that currently thwart access to open and interoperable systems, such as "special" training by EHR developers, nondisclosure contracts, the imposition of additional fees to access data and customized programming that only a developer can do.  

The failure of EHRs to freely share data among each other has become a primary concern, especially since billions of dollars have been spent by the government and providers on EHR adoption. Both providers and vendors have been found to be guilty of information blocking, which contributes to the lack of interoperability. ONC has recommended a roadmap to increase interoperability over the next 10 years.

To learn more:
- read the article