Success of EHR Depends on Standards

Despite years of discussion and debates between doctors, providers, government agencies and other industry organizations, there are still doubts about what interoperability even means, and if and when the healthcare industry will achieve it.

In 2014, the Office of the National Coordinator for Health Information Technology (ONC) set 2024 as the year "individuals, care providers, communities, and researchers should have an array of interoperable health IT products and services (and) individuals should be able to securely share electronic health information with care providers, and make use of the information to support their own health and wellness."

Congress is even more bullish. In passing the Medicare Access and CHIP Reauthorization Act (MACRA) last year, it made it "a national objective" for EHRs to be interoperable by the end of 2018. There isn't a lot of confidence in those deadlines though.

One survey, published in 2015 by document management solutions provider Scrypt, found just 17 percent of the more than 700 healthcare providers it polled are confident the healthcare industry could meet the ONC goal. There has not yet been a similar survey for the MACRA target.

It's not that healthcare providers don't believe in the advantages of EHRs and the necessity for effective digital collaboration. At the beginning of 2016, the ONC said 77 percent of all physicians enrolled in its Regional Extension Centers around the country had demonstrated meaningful use of certified EHR technology. Likewise, more than 88 percent of critical care access hospitals participating in the Centers for Medicare and Medicaid (CMS) EHR incentive program had demonstrated meaningful progress. They had at least implemented or upgraded an EHR. Some 56 percent of office-based physicians had done the same.

The underlying problem is hundreds of different EHR products and thousands of different implementations, many customized and personalized to fit the needs of one specific health organization, and none built on a consistent set of standards. To achieve true interoperability, EHRs must speak a common language, enabling systems to seamlessly share information and have that information understood by all varieties of EHR. To say this has proven difficult is an understatement.

MACRA defines interoperability as the ability for two or more disparate health technologies to exchange clinical information and use that information under a standard set of guidelines to coordinate patient care. The ultimate goal is to improve patient outcomes. Under the law, the Department of Health and Human Services is to develop a set of metrics it will use to determine if the 2018 goal is achieved.

In 2013, HIMSS published a three-level concept for interoperability. The first is a foundational level that allows for sending and receiving data, but not a full understanding. The second is structural, and provides for systems to exchange and interpret data. The third is semantic, and adds the ability to use a common vocabulary.

"Everybody has that foundational ability," says Spencer Hamons, chief information officer for NetApp's healthcare division. "Few have any semantic capability, so it would be fair to say there's a widely varying level of maturity when it comes to interoperability."

Success relies on communication as the cornerstone of interoperability. It starts with standards that serve as the building blocks and form a foundation for innovation. With a universal framework in place, agencies can establish a system they can use today and adapt for whatever the future brings.