Meaningful use stage 2 proposes stricter requirements for health interoperability, particularly in two areas -- first, porting more data from systems such as e-prescribing and radiology information systems into electronic health record (EHR) systems, and, then, porting those patient records to a wider network that includes health information exchanges (HIEs) and the patients themselves.
For people trying to get all these disparate information systems talking with each other, it's far easier to discuss interoperability principles than to make it happen. However, health care providers' need for interoperability extends much further than meaningful use compliance in order to earn money through the EHR Incentive Programs. The data needed for state and federal quality programs and accountable care organization (ACO) reporting may also be marooned in proprietary data silos on the network.
"You have to be able to respond to whatever's needed," said Ed Ricks, CIO of Beaufort (S.C.) Memorial Hospital, a 200-bed facility that has completed meaningful use attestation for stage 1. "It may not be meaningful use; [sometimes it's] quality data from our systems."
Piping data into Ricks' main Medical Information Technology Inc. system are more than 150 different clinical applications, other EHR applications (including specialty EHR systems and EHR software modules) and hardware devices. Lacking the bandwidth to hand-code his own interfaces for all these connections to Meditech, Ricks contracted Summit Healthcare Services Inc., a systems integrator that developed an interface engine certified to meaningful use criteria, to make his network interoperable.
If we go forward with direct clinical quality reporting, today, as a stage 2 requirement, we'll get such wildly different results that it will be unusable.
Dave Delano, project director, REC for New Hampshire, Massachusetts eHealth Collaborative
"There's challenges within an organization because there's just so many vendors that offer different, disparate solutions," said Summit CEO Ted Rossi.
Paper presents another health interoperability challenge for providers, Ricks added. Beaufort, which owns eight primary care practices employing a total of 25 physicians and connects to most of the other independent physicians in its community, still has to contend with porting paper documents into the electronic medical record and the complexities entwined in a paper-and-digital EHR workflow.
Can meaningful use, reporting mandates get vendors on health interoperability bandwagon?
Vendors might be incentivized to not play well in the health interoperability sandbox -- if it's simple for customers to move their patient data between apps, then they can more easily drop a vendor when they're unhappy.
In Ricks' view, though, health IT vendors should get on the interoperability bandwagon if they want to survive. He doesn't mind the federal government nudging vendors toward interoperability by hardwiring more granular data standards into regulations such meaningful use.
In the case of the Continuity of Care Document (CCD), for example, Ricks hopes future stages of meaningful use will be more prescriptive, for interoperability's sake. CCDs are perhaps the biggest health interoperability pain point he has to work through. While data standards are in place, they're vague enough to allow different software vendors to implement them differently. It's hard to make them all consistent under one Meditech roof, he said.
Outside of meaningful use help, the cause of health interoperability would advance if the federal government would harmonize its health care reporting mandates, too.
Learn more about health interoperability challenges
"Capitalism is going to prevail, right? The best vendors will make the best solutions that people will end up buying those in the long run, whether they're interoperable or not. We're seeing that today already, some of the big vendors are sunsetting some of their products," Ricks said.
"We absolutely understand that we have to format data in an exact way to get paid. Unfortunately, Medicare does it one way, Medicaid does it another way, Blue Cross -- depending on which Blue Cross -- might be a little different. They should all be the same. [It] seems like CMS should end up controlling that at some point. That makes the most sense."
Lack of health interoperability leaves HIEs struggling to standardize patient records
Apples-to-oranges issues arising from differing implementations of "standards" among software vendors plague HIEs, too. Dave Delano, project director for the Regional Extension Center for New Hampshire for the Massachusetts eHealth Collaborative, which also administers the Massachusetts and New Hampshire state HIEs and supports federal quality reporting programs, likewise hopes meaningful use rules will eventually clarify standards for the sake of interoperability.
The standards are still not there to generate repeatable quality results, side-by-side, he explained. In testing, his organization has seen how two quality information systems, running reports from the same source data, can generate different results. When that happens, it's difficult for the health care system to get actionable quality data.
"With interoperability, it's still about those standards," Delano said. "Until we get to standards and definitions and understandings that are consistent enough…if we go forward with direct clinical quality reporting, today, as a stage 2 requirement, we'll get such wildly different results that it will be unusable."