EHR regulations, interoperability top patient record concerns
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The industry has made progress toward healthcare interoperability in the last couple years, but getting over the final hump may take some creative thinking. There are still no easy answers for how to build fully interoperable nationwide networks.
At the Massachusetts Institute of Technology CIO Symposium, held May 22 in Cambridge, Ma., Beth Israel Deaconess Medical Center CIO John Halamka, M.D., said significant progress has been made.
In particular, he pointed to the growing role of the Clinical Document Architecture (CDA) standard. Under the 2014 Certification Standards, EHR software must be able to produce transition of care documents in this form.
But not every vendor has reached the point where it fully supports this standard, and it is not the universal default for clinician data entry. Additionally, Halamka pointed out that information in health records tends to be incomplete. Often the worker responsible for entering important demographic data and other information into the record is the least-trained person on the staff, which can increase the risk of errors and produce bad data.
There are ways around the lack of vendor support for healthcare data interoperability. Halamka said most states' information exchanges can function as middleware. As an example, he talked about how Beth Israel is able to exchange information with Atrius Health, a group of community-based hospitals in Eastern Massachusetts, across the state's HIE even though the two networks are on different systems.
"You can get around what the vendor is able to do with middleware," Halamka said.
But while these incremental changes have improved data interoperability, supporting full interconnectedness across all vendor systems and provider networks could take some new solutions.
Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, said healthcare remains fragmented. This means there is no single stakeholder with the market power to enforce adoption of a single standard. Medicare and Medicaid are the biggest payers, and the Centers for Medicare and Medicaid Services (CMS) is encouraging interoperability for that reason. But Tripathi said the reach of CMS can only do so much.
Meaningful use is the main lever CMS can pull to encourage adoption of standards. But because this program mainly deals with reimbursements, its reach is limited, Tripathi said. For example, laboratory and radiology centers are less beholden to Medicare and Medicaid reimbursements than primary care doctors and hospitals. Meaningful use is less of an incentive for them to adopt interoperable systems.
But other methods could still reach these providers. Tripathi pointed out the majority of laboratory services are delivered by in-hospital departments. It could be possible to include provisions in the next round of EHR certification standards that would force hospitals to implement systems that utilize interoperable standards for laboratory systems.
This may be one way to impose data interoperability on segments of healthcare that are less influenced by the meaningful use rules, but it is not the only one. In a presentation at the April meeting of the Health IT Policy Committee, Tripathi made several suggestions to encourage healthcare interoperability. He recommended greater collaboration between CMS and private payers on payment reform. He also called for an increase in the amount of federal data available in standardized formats so innovators can produce new systems that start with a common language. He then proposed that reporting requirements for all government quality programs be aligned with those of meaningful use so that providers who are not participating in the EHR incentive program are exposed to the same set of standards.
ONC, HHS pledge $28 million toward health IT interoperability across as many as 12 states