Stage 2 certified EHRs not ready for interoperability

The current architecture for data exchange required by Stage 2 of Meaningful Use does not allow for "robust" patient data sharing, according to a new study in the Journal of the American Medical Informatics Association (JAMIA).

The study, conducted by researchers from the Office of the National Coordinator for Health IT-funded Substitutable Medical Applications and Reusable Technology (SMART) C-CDA Collaborative, evaluated the Consolidated Clinical Document Architecture (C-CDA) for document exchange. C-CDA is a library of templates to transmit patient data in structured and unstructured formats. Electronic health records must produce C-CDA documents to meet Meaningful Use Stage 2.

The researchers obtained 91 C-CDA sample documents representing 21 distinct technologies from 107 health IT organizations, looking for errors that would not satisfy Meaningful Use, and for heterogeneity in structured data. They found 11 specific areas of errors and variability that create barriers to interoperability.

Common "trouble spots" included omission or misuse of allergic reactions, omission of dose frequency and omission of results in interpretation. Unfortunately only some of the barriers to interoperability could be detected automatically.

"Although progress has been made since Stage 1 of MU, any expectation that C-CDA documents could provide complete and consistently structured patient data is premature," the researchers warned. "Based on the scope of errors and heterogeneity observed, C-CDA documents produced from technologies in Stage 2 of MU will omit key clinical information and often require manual data reconciliation during exchange."

The researchers recommended several steps to improve interoperability, such as providing richer, more standardized samples in public accessible format, reduction of data optionality, validation of codes and vocabulary and better monitoring to track real world document quality.

"However, without timely policy to move these elements forward, semantically robust document exchange will not happen anytime soon," the authors concluded.

Interoperability has become a front burner issue for ONC, especially as Stage 2 of Meaningful Use requires enhanced data exchange. Many providers have been struggling to meet the requirements, prompting CMS to propose relaxing them for 2014. ONC also recently announced a new 10 year plan to increase interoperability.

To learn more:
- here's the study

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