Interoperability Depends On EHR Vendors: AHA

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It would, however, like the government to demand more from electronic health record (EHR) vendors to advance interoperability at several different levels, according to an AHA letter to the Office of the National Coordinator of Health IT (ONC). The AHA sent the letter in response to the ONC's request for information (RFI) on how to increase interoperability.

From the AHA's viewpoint, healthcare payment and delivery reforms, coupled with the government's Meaningful Use requirements, are all that's required to propel providers along the path to more effective health information exchange. What stands in the way of that, however, are external barriers. Hence the AHA would like ONC "to remove barriers for interoperability and support development of a robust infrastructure for health information exchange."

[ Are poorly designed electronic healthcare record systems driving medical personnel back to paper? Read Healthcare Workarounds Expose EHR Flaws. ]

"The federal government already has a remarkable number of requirements to share information," said Chantal Worzala, director of policy for the AHA, in an interview with InformationWeek Healthcare. "If you look at the Meaningful Use stage 2 requirements, whether you're reporting to public health or sending transition-of-care documents to the next provider when a patient leaves the hospital or is referred to another physician, those requirements already exist. Also, the rules require providers to give patients access to their information via a portal."

The challenge is that providers don't have the infrastructure in place to meet existing requirements, said Worzala. "So we'd prefer that the government focus on removing the barriers to the exchange that [is] required under Meaningful Use or [is] incentivized via programs like the Accountable Care Act," she said.

Among other things, the AHA letter said that EHR vendors should be required to use the same medical terminology for 2014 certification. However, the most important such requirement in the ONC's current certification criteria -- that all EHRs use the SNOMED-CT vocabulary for problem lists -- is an issue for AHA partly because it duplicates the ICD-10 coding system that the industry must move to next year. AHA said the ONC should require the ability to "cross-walk" from SNOMED to ICD-10 in certified EHRs.

Worzala noted that SNOMED is not widely used in the U.S., even though it was developed here. AHA is concerned that providers lack the technical and educational resources and the strategic plans to implement problem lists based on SNOMED by Oct. 1, 2013, when Meaningful Use Stage 2 goes into effect for hospitals. The key challenge seems to be that doctors aren't sure how well their diagnoses will be translated into a uniform terminology like SNOMED. So healthcare organizations would like to see the mapping to SNOMED better vetted and tested.

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