Meaningful Use Stage 3 should embrace interoperability at its core to foster creation of a truly interoperable health data infrastructure, according to a report conducted by JASON, an independent group of scientists that advises the U.S. government on science and technology.
"The current lack of interoperability among the data resources for EHRs is a major impediment to the effective exchange of health information," the report states. "These interoperability issues need to be solved going forward, or else the entire health data infrastructure will be crippled."
The report, commissioned by the Agency for Healthcare Research and Quality (AHRQ), expresses disappointment in U.S. progress toward the creation of a robust health data infrastructure, but praises the U.S. Department of Health & Human Services and Office of the National Coordinator for Health IT for their continued work on the problem.
"The criteria for Stage 1 and Stage 2 Meaningful Use, while surpassing the 2013 goals set forth by HHS for EHR adoption, fall short of achieving Meaningful Use in any practical sense," the report says. "At present, large-scale interoperability amounts to little more than replacing fax machines with the electronic delivery of page-formatted medical records."
The authors call for the Centers for Medicare & Medicaid Services to, within the next 12 months, define an overarching health data infrastructure that's interoperable, protects patient privacy, and facilitates access for clinical care and biomedical research.
More than a common markup language for storing electronic health records will be required, they say, pointing to the need also of published application program interfaces (APIs) that allow third-party programmers to bridge from existing systems to a future software ecosystem that will be built on top of the stored data.
The report also outlines what this new software architecture should look like, proposing, among other things, that it:
- Be agnostic as to the type, scale, platform, and storage location of the data
- Use public APIs and open standards, interfaces, and protocols
- Encrypt data at rest and in transit
- Separate key management from data management
- Provide a migration pathway from legacy EHR systems.
National Coordinator for Health IT Karen DeSalvo (pictured), in a Health IT Buzz blog post on the report, says that CMS has already started to work on many of the author's recommendations, and that interoperability will be at the forefront of discussions as it refreshes its Federal Health IT Strategic Plan in the coming months.
HHS has not sufficiently addressed data-exchange problems, concluded a Government Accountability Office report issued last month.
Interoperable systems were a key focus in the eHealth Initiative's public-private collaborative effort, eHealth Initiative 2020 Roadmap, to create a vision for healthcare through the end of the decade.