Stakeholders to ONC: No one architecture perfect for EHRs, data sharing

Interoperability is a major part of Stage 3 of Meaningful Use, but the timeframes may be too short to transition from current Consolidated Clinical Document Architecture (C-CDA) used in Stage 2 to the application program interfaces (APIs) and proposed HL7 Fast Healthcare Interoperability Resources (FHIR) Standard for Stage 3, according to vendors and stakeholders speaking at a recent joint Health IT Policy and Standards Committee listening session.

At the session, which explored whether APIs should be considered for electronic health record interoperability, witnesses expressed concern with both types of architecture, noting that C-CDA was not perfect, but--as Anil Sethi, CEO of GLIIMPSE, testified--that FHIR "was not ready for prime time." The Health IT Standards Committee implementation workgroup acknowledged in its meeting July 28 that the C-CDA for document exchange was faulty. EHRs must produce C-CDA documents to meet Stage 2 of the Meaningful Use program.  

Carl Dvorak, president of Epic Systems, suggested that the industry does not necessarily need to rework technical architecture. He also said that since EHRs already share data constantly, such as in e-prescribing, a recent JASON report that expressed concern about the lack of interoperability among EHRs was a "false premise." Dvorak recommended that what's really needed are standards and "basic governance."

JASON is an independent group of scientists that advises the government on science and technology.  

Some witnesses pointed out that EHR developers really don't want to share data with other systems, regardless of the vehicle used.

"EHR vendors have no greater desire to interoperate than does Target wish to share their customer ERP data with Walmart," Sethi said. "It is not reasonable to think that an API or an elegant JASON architecture will overcome the economic disincentives to sharing patient data."

The Office of the National Coordinator for Health IT intends to use Stage 3 of the Meaningful Use program to create a "robust" infrastructure for interoperability and is in the process of determining how best to attain that goal. The agency released an outline of a 10-year plan on interoperability in June.

To learn more:
- here are the meeting materials

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