EHR interoperability is more likely to come from horizontal integration than vertical health IT integration, experts say.
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Interoperability between disparate electronic health record (EHR) systems was a major focus of the conversation and the announcements at the recently concluded annual conference of the Health Information Management and Systems Society (HIMSS) in New Orleans. A partial list of the developments related to health information exchange at HIMSS includes the following:
-- Five major EHR vendors -- McKesson, Cerner, Allscripts, Greenway and athenahealth -- announced the formation of the CommonWell Health Alliance, which is designed to increase interoperability among their systems. They urged other EHR suppliers to join their alliance.
-- Judy Faulkner, CEO of Epic Systems, told Bloomberg News that her company had not been invited to join CommonWell, and she charged that the alliance was a "competitive weapon" to be used against Epic.
-- The Certification Commission for Health IT (CCHIT), a nonprofit organization, said that it would soon start testing certification of health information exchanges for their ability to provide "plug and play" connectivity with each other and with EHRs. CCHIT will offer this certification under a contract with the Interoperability Work Group (IWG) and the eHealth Exchange, the successor to the Nationwide Health Information Network Exchange (NwHIN).
-- Healtheway, the nonprofit company that manages the eHealth Exchange, launched a collaboration with the Care Connectivity Consortium (CCC), which was founded by Kaiser Permanente, Geisinger Health System, Group Health Cooperative, Intermountain Healthcare and Mayo Clinic. Through this partnership, CCC will do R&D for the eHealth Exchange and give its members access to advanced services in areas such as patient matching, consent management and, eventually, population care.
-- Allscripts acquired db Motion, a vendor of HIE and population health management solutions.
To be understood, all of this has to be viewed in the context of three facts of life in health IT. First, the meaningful use stage 2 criteria, which kick in next year, include interoperability criteria that exceed the capabilities of most providers today. Second, the industry is moving toward accountable care and population health management, requiring new responses from EHR and HIE vendors alike. And third, this historic trend is likely to change how healthcare providers view the offerings from health IT vendors as their perspective broadens beyond their enterprises.
Right now, the trend is still moving in the opposite direction: An increasing number of healthcare organizations are switching from their current best-of-breed systems to Epic, which offers proven, physician-accepted solutions that are integrated across hospitals and ambulatory care. That's understandable, because Epic eliminates most of the need for complex, hard-to-maintain interfaces within enterprise systems.
This movement explains the jockeying that is going on between Epic and its leading competitors, which would like to reduce Epic's advantage in systems integration by becoming interoperable with each other. At the same time, this approach will help them give their customers the interoperability they need to show meaningful use.
But in an interview with InformationWeek Healthcare, Doug Fridsma, director of the office of science and technology in the Office of the National Coordinator for Health IT (ONC), said that the "vertical integration" approach in vendor product suites was outdated. "In accountable care organizations and in the new ways in which healthcare is being delivered, they're going to become less vertically integrated and more horizontally integrated," he predicted.
Because of the need for interoperability across care settings and business entities, he added, "Vendors that try to sell everything to people will have increasing problems."
In regard to the launch of CommonWell, Fridsma said, "Any efforts that improve information flow are a good thing." The willingness of vendors to open their systems and establish standards for information exchange, he noted, is a positive step as long as its purpose is to improve the quality of care.
While CommonWell, the IWG/eHealth Exchange consortium and the Surescripts clinical interoperability network are all trying to achieve the same goal, Fridsma saw no problem with that if all of these initiatives adhere to certain nationally recognized standards. He compared this evolution to that of the Internet, which is based on standards such as FTP and HTTP.
Similarly, he said that it was fine if the IWG/eHealth Exchange allows HIEs and EHRs to connect to each other and the eHealth Exchange through multiple gateways, rather than using the CONNECT software that the government developed for federal agencies to connect to the NwHIN. "Interoperability should not be predicated on everybody using the same software or systems," he said.
Mariann Yeager, executive director of Healtheway, and Anuj Desai, director of business development for the New York eHealth Collaborative (the moving force in the IWG), told InformationWeek Healthcare they were not worried about CommonWell. "Anything that can help systems be more interoperable and be standards-based is a good development," Desai said.
CCHIT's HIE compliance testing and certification program will include three components:
-- HIE Certified Community for EHRs and other health IT systems, enabling clinicians to query an HIE for information on specific patients within a state.
-- HIE Certified Direct, a protocol that gives providers a simple way to send secure health information directly to other providers and patients. Desai said that the government's EHR certification requirements for Direct are less rigorous than the criteria that CCHIT will use in testing on behalf of IWG/eHealth Exchange.
-- HIE Certified Network for HIE-to-HIE connectivity and the connection to the national eHealth Exchange.
"The idea is to make it simple," Desai said. "If providers see these seals on [EHR and HIE] products, they'll know they're plug and play."
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