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Interoperability Depends On EHR Vendors: AHA

Providers don't need more regulation -- they need fewer obstacles to complying, says hospital association in reply to government's request for information on interoperability.
Another major conundrum for AHA is the requirement that EHRs be able to send and receive secure messages using the Direct Project email protocol. Although this is fundamental to being able to exchange clinical summaries at transitions of care in Meaningful Use stage 2, AHA is unclear on whether providers will actually be able to access these documents through Direct and incorporate them into EHRs. It would like the government to publish results of its Direct pilots with statewide HIEs.

In addition, the association wants the ONC to require vendors to incorporate the SOAP transport standard "for more robust exchange of computable data." Under the current regs, Direct capability is required but SOAP and another transport standard are optional.

Another big AHA concern is that state health departments and immunization registries might not gear up to accept electronic data from providers in time to meet the MU stage 2 criteria. The AHA urges the Centers for Medicare and Medicaid Services (CMS) to redouble its efforts in this area, while expressing appreciation for the work that's been done so far to enable nearly 1,000 hospitals to send lab data conforming to the LOINC standard to public health agencies. The association also calls on CMS to develop a website showing the ability of these agencies to receive the data that providers must send them under the MU stage 2 rules.

In addition, AHA wants the government to explore the possibility of using national provider identifiers (NPIs) to create comprehensive directories of providers for use in secure messaging. And to address the patient matching problem, which now requires provider organizations to create expensive and separate master patient indexes, the AHA suggests that HHS look into re-using the consumer ID system being developed for state health insurance exchanges. Finally, it wants the government to deal with variations in state privacy laws and strictures in the HIPAA regulations that inhibit health information exchange.

An earlier response to the ONC RFI from the College of Healthcare Information Management Executives (CHIME) requested the government to certify HIEs "via standard interfaces, standard methods for isolating sensitive information, standard means to securely transport patient care information (i.e., Direct), standard ways to accurately identify patients and standard protocols for tracking consent."

Worzala said the AHA had not spoken to CHIME about this proposal, but added, "There's a lot of agreement between AHA and CHIME on the need for technology to support interoperability."

Neither the AHA nor the CHIME letter referenced the work that is being done by the Interoperability Work Group and Healtheway to certify HIEs with the help of the nonprofit Certification Commission for Health Information Technology (CCHIT).