The agreement by seven states, eight electronic health record vendors, and three health information exchange vendors on an initial set of standards for exchanging health data is a major step toward the interoperability that has so long defied the best efforts of technologists and policymakers.
The achievement of the EHR/HIE Interoperability Workgroup is important for several reasons. First, standardization will decrease the cost and accelerate the process of connecting EHRs to HIEs, be they statewide or local. Second, insofar as the workgroup hews to national standards, it will lay the groundwork for connecting HIEs to the Nationwide Health Information Network (NwHIN). And third, this initiative has the potential to break down the barriers between disparate EHRs.
Just to give some idea of how siloed the different systems are, the Continuity of Care Document (CCD)--the main hope for interoperability, so far--still moves from one EHR to another as a document without the data being able to flow into discrete EHR fields. Based on HL7's Clinical Document Architecture (CDA), the CCD is several years old, and the ability to generate CCDs has been a requirement for EHR certification by the Certification Commission for Health IT (CCHIT) since 2008. So one might have thought there would have been more progress on this front--especially since the Meaningful Use rules accept the CCD as a vehicle for data interchange.
The CCD is one of the standards that the interoperability workgroup used in developing specifications for its Statewide Patient Inquiry Service, which allows clinicians to locate information on a particular patient. It also leveraged the IHE Profiles and NwHIN exchange to facilitate patient queries and CCD retrieval.
The workgroup also used an existing standard in developing its Statewide Send and Receive Patient Record Exchange specification, which describes how encrypted health information can be transmitted point-to-point over the Internet. According to the workgroup's website, this is based on the Direct Project, a specification for secure clinical messaging that was developed by a public-private consortium.
The most encouraging part of all of this is that some leading EHR vendors are cooperating in the interoperability effort. (It's good that three HIE vendors--including Axolotl and Medicity, the two biggest firms--are in the workgroup, too, but you'd expect that they would be.) True, some of the biggest companies--including Epic, Cerner and Meditech--are not yet onboard; but it's hoped that as the initiative bears fruit, it will attract more vendors and states.
Naturally, comments by the participating EHR vendors are bland, focusing on the need to transform healthcare, improve quality, lower costs, and so on. But their partnership with the statewide HIEs--which, across the country, have yet to prove their financial viability and sustainability--is an indication that the vendors believe the public, communitywide HIE model is going to be important moving forward.
Could that be because they see accountable care organizations in their future? Possibly. But I also think the EHR vendors are starting to recognize that they can gain from collaborating on some levels, while they continue to compete on others. - Ken