white paper explaining how vendors can meet the data transport requirements for EHR certification in Stage 2 of the government's Meaningful Use EHR incentive program. The paper also suggests how the transport standards could pave the way for greater interoperability among disparate EHRs.
To meet the Stage 2 criteria, hospitals and eligible professionals must provide an electronic summary of care record during at least 10% of transitions of care and referrals. They can either transmit the information from their EHR to the EHR of the recipient, or they can use a health information exchange that is part of or consistent with the Nationwide Health information Network Exchange (now called the eHealth Exchange). In addition, they must conduct one or more successful electronic exchanges of a clinical summary with a recipient that uses an EHR that's different from the sender's, or with a CMS-designated test EHR.
The Office of the National Coordinator for Health IT (ONC) has specified how EHR vendors must integrate the capability of exchanging data in their EHRs in order to be certified. "The standards [for interoperability] are incorporated by reference into the regulations," explained Mark Segal, chair of the public policy leadership group of EHRA, in an interview with InformationWeek Healthcare. "We wanted to translate the regulatory standards and technical language into a context that works for our members and that they can incorporate [into their products]."
[ Study shows that half of infection prevention specialists don't know if their organization uses an EHR. Read more at EHRs Underused For Hospital Infection Reporting. ]
ONC requires that all vendors include a capability to use the Direct secure messaging protocol, which has been gaining traction in the industry. A form of secure e-mail, Direct can be used to send the Comprehensive CDA (CCDA), a standardized clinical summary, from one EHR to another. Addressing and authentication of Direct messages are typically done through what is known as a health information service provider (HISP). Segal, who is also vice president, government and industry affairs for GE Healthcare IT, pointed out that the EHR vendors must get certified in combination with one or more of these HISPs.
ONC also describes two optional transport methods that can be added to the Direct capability. Segal believes that many, if not most, vendors will certify for at least one of these options. The first method builds on Direct in that it relies on secure e-mail. However, it uses a metadata "wrapper" that allows for improved routing and privacy and security management without requiring that the document be opened.
The second approach uses the SOAP, or Web services, model rather than e-mail as the transport mechanism. Besides the advantages of the metadata wrapper mentioned above, the SOAP method makes the transmission independent of the HISP or HIE receiving the message, the white paper explains, "in that an EHR need not be certified with the …HIE/HISP chosen by the provider."
What this means, Segal said, is that if a provider wants to use a HISP that its EHR vendor is not certified with, it can do so without getting the vendor to add or self-certify with that HISP. "With this [SOAP] model, they'd have more flexibility and could use this model to connect with a different HISP and still be consistent with Direct addressing."
In addition, he said, this method doesn't require a HISP. A provider could use it to communicate with an HIE that employs a specific kind of data profile known as XDR, as long as the provider has a certificate issued by a certifying authority. (XDR is one of the standard profiles created by Integrating the Healthcare Enterprise, or IHE.)
Even more important, Segal noted, the Web services mechanism is a steppingstone toward a search capability that would be more useful than point-to-point Direct messaging. "It has the components of what you'd want to search for -- the metadata wrapper around the CCDA is useful there. Then being able to connect with IHE profiles means you can connect with HIEs that have query-based exchange."
Segal added that the data transport mechanism is just one of the "building blocks for interoperability" in Meaningful Use Stage 2. Another building block is the requirement that EHR vendors use standard clinical vocabularies, such as SNOMED CT for problems, RxNorm for medications and LOINC for lab results. The CCDA -- an enhanced form of the Continuity of Care Document -- is another step in this direction.
"All of that moves you toward more standards-based interoperability, allowing data to move from one provider to another and one EHR to another," Segal said.
As large healthcare providers test the limits, many smaller groups question the value. Also in the new, all-digital Big Data Analytics issue of InformationWeek Healthcare: Ask these six questions about natural language processing before you buy. (Free with registration.)