Stakeholders to ONC workgroup: EHRs too variable to be interoperable

Electronic health records don't share data well--and the Office of the National Coordinator for Health IT is listening, having dedicated its most recent Health IT Standards Committee implementation workgroup meeting to the problem.

At the July 28 meeting, workgroup co-chairs Liz Johnson and Cris Ross acknowledged that the Consolidated Clinical Document Architecture (C-CDA) for document exchange--the library of templates to transmit patient data in structured and unstructured formats--was faulty. Some of the identified problems included mismatches between codes, vocabulary that was too broad for some data elements, missing information and "significant variability" in how information is sent, which makes it hard for those on the receiving end to integrate it into a local system.

EHRs must produce C-CDA documents to meet Stage 2 of the Meaningful Use program.

Representatives of both providers and vendors testified to users' experiences and frustrations with C-CDA. Matt Reid of the American Medical Association noted that no single C-CDA document template contains all of the data requirements to sufficiently meet Meaningful Use compliance. He also stated that implementation guidance is lacking and that ONC should "constrain" optionality and limit future Meaningful Use requirements to ones that are well tested and understood.

Micky Tripathi, founding president and CEO of the Massachusetts eHealth Cooperative, noted that interoperability was "cumbersome" because of the wide variation in data availability and semantic normalization. Several vendors reported differing levels of success in interoperability.    

The workgroup will make recommendations to the full committee on Aug. 20

The lack of interoperability has been identified as a major problem in the implementation of EHRs and the progression of Meaningful Use. A recent study in the Journal of the American Medical Informatics Association revealed that the C-CDA architecture had 11 specific areas of errors and variability that hamper interoperability and warned that robust document exchange "will not happen anytime soon."

Those problems have also caught the attention of congressional leaders, who have derided the Meaningful Use program for paying incentives to vendors whose products hinder data sharing, with one Congressman calling lack of interoperability a "fraud" against the American taxpayer.

To learn more:
- check out the materials for the implementation workgroup meeting