Interoperability Initiative Poised To Transform Healthcare

A public-private consortium is about to make a quantum leap in the interoperability among disparate electronic health record (EHR) systems and health information exchanges (HIEs). If the initiative is successful, it will provide "plug-and-play" connectivity between EHRs and HIEs and between HIEs. This would drastically cut the expense of interfaces and would allow more than half of the U.S population and their healthcare providers to access health data shared among multiple states and systems.

As previously reported, Healtheway, the new private-sector entity that operates the eHealth Exchange (successor to the Nationwide Health Information Network or NwHIN Exchange), has partnered with the EHR/HIE Interoperability Work Group to implement standards that will make it easier to exchange health information. The Interoperability Work Group (IWG), led by the New York eHealth Collaborative (NYeHC), is a consortium of 15 states, 19 EHR vendors, and 18 HIE vendors that has been developing implementation guides for interoperability since February 2011.

IWG and Healtheway have now selected the Certification Commission on Health Information Technology (CCHIT) to perform the testing and certification of EHRs and HIEs, as well as of providers that wish to connect with the eHealth Exchange. CCHIT, the oldest U.S. EHR certification body, is one of the entities designated by the Office of the National Coordinator of Health IT (ONC) to certify EHRs that providers can use to meet Meaningful Use requirements.

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That's not surprising, because the standards developed by the IWG are closely aligned with those required for Meaningful Use stage 2. Those include an advanced version of the Continuity of Care Document (CCD), which is a clinical summary, and other types of documents that incorporate the Consolidated Clinical Data Architecture (CDA), said Dennis Wilson, director of technology and testing for CCHIT, in an interview with InformationWeek Healthcare.

These standards encompass both the transport mechanisms and the specified content that EHR and HIE vendors will have to employ for a variety of use cases when their systems exchange information. The transport standards encompass Web services profiles used in querying systems and the Direct messaging protocol that many regional and statewide HIEs use to push data from one provider to another, Wilson noted. The Web services profiles were developed by Integrating the Healthcare Enterprise (IHE), a long-established group in the health IT industry.

CCHIT will employ Aegis, which has a long history with the NwHIN Exchange, to provide a cloud-based testing environment in which vendors can prepare to have their systems tested on a variety of use cases. But CCHIT itself, not Aegis, will do the testing and certification on behalf of IWG, beginning in January. Alisa Ray, executive director of CCHIT, said her nonprofit firm will charge fees to entities that wish to be certified, just as it does to EHR vendors that want to get Meaningful Use certification.

"The compliance testing covers the ability for systems to exchange information using those transports and payloads [i.e., content]," Wilson noted. But CCHIT will not certify the third part of plug-and-play interoperability--the ability for information downloaded from an HIE to go directly into an EHR's data fields. Each vendor takes a different approach to this "reconciliation" process, he noted. Some let doctors decide whether to allow data from a trusted source, such as medications or diagnoses, to go directly into their EHRs. Others require clinicians to look at every piece of data before it's added to their record.

There will be a multistage process for healthcare providers to hook up with the eHealth Exchange (EHE), Wilson explained. First, they have to purchase an IWG-certified EHR. Then they must apply to Healtheway and meet its requirements for membership in the EHE. After that, CCHIT will test and certify the provider's implementation of that EHR. If they pass, they'll get an EHE digital certificate.

There are still some significant holes in the interoperability scheme. Few regional HIEs are part of the IWG, although Wilson expects that to change. No provision has yet been made for post-acute care EHRs. And while some major EHR vendors belong to the consortium--including Allscripts, Cerner, eClinicalWorks, Epic, GE, NextGen, and Siemens--many more are not yet aboard.

Wilson said he expected more vendors to join because the health IT regional extension centers (RECs) are writing the interoperability criteria into their contractual requirements for EHR companies. "If the vendors want to do business in those states, especially if this continues to scale up to more states, they'll have to comply," he said. Ray agreed, adding that providers will also start asking their vendors for this capability.

David Whitlinger, executive director of the New York eHealth Collaborative, told InformationWeek Healthcare that the IWG initiative could be a breakthrough for both physicians and HIEs. Plug-and-play interoperability, he noted, would give doctors the ability to access all of the available information on a patient within an integrated workflow, while reducing the cost of connecting with HIEs.

"One of the principal reasons why providers struggle with HIEs is the broken workflow," he said. "If you have to jump over to an HIE portal to look up the record, and there's no way to get those records into your own EHR, it's really a hard workflow. And the physician community has rightly said, 'This isn't working for us.' That's why we're making the EHRs technically fully integrated with the HIE."