Why Take EHR Data Out Of Structured Format?

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Even as the forthcoming Stage 2 of the Meaningful Use electronic health records (EHR) incentive program is supposed to encourage healthcare providers to put patient data in structured format, an important standards development organization has developed a tool to convert some structured data to plain text. But the move may not be as unusual as it seems at first glance.

Health IT standards organization Health Level Seven International (HL7) released a tool to convert patient-specific data in the HL7-sanctioned, XML-based Continuity of Care Document (CCD) format to unstructured text, as specified by the Blue Button initiative.

Created at the U.S., Department of Veterans Affairs in 2010, Blue Button is meant to simplify patients' access to their own medical records, allowing them to download their information to personal health records (PHRs) or print a copy simply by clicking on a blue button displayed prominently on an EHR portal page. Officials at the U.S. Department of Health and Human Services (HHS) last year embarked on a campaign to make Blue Button a de facto standard for patient engagement in the private sector, even though it does call for unstructured data.

[ Can patient engagement help transform medical care? See 5 Healthcare Tools To Boost Patient Involvement. ]

"The VA's environment is mostly MUMPS," noted HL7 CTO John Quinn, referring to a programming language that dates to the late 1960s.

"When this initiative was originally started, you had to sign a license with the VA," added CCD Blue Button tool project manager Lenel James, whose full-time job is senior project manager of the Information Standards and eHealth team at the Blue Cross and Blue Shield Association. "You had to have an ASCII, human-readable version [as a minimum.]"

In December 2011, the U.S. government's Office of Personnel Management (OPM) asked health plans participating in the Federal Employee Health Benefit Program to add Blue Button capabilities to their member portals. To do so, payers must offer downloads in both machine-readable and human-readable formats.

HHS hasn't provided a lot of detail on what 'human-readable' means, according to James. "This HL7 tool provides a format that is clear and unambiguous," he told InformationWeek Healthcare.

The conversion tool may be a temporary measure, James suggested, or it may be permanent if it works. He said HL7 is developing an implementation guide to help make CDA data human-readable.

James said Kaiser Permanente and the HL7 PHR workgroup were drivers of the effort to create the tool, and Kaiser has agreed to use the data converter as it strives to meet Stage 2 Meaningful Use requirements starting in 2014. Stage 2 will require providers to offer portal access to health records for at least half of their patients, and 5% of patients actually have to use the portals.

Other early adopters include Centerstone, a major provider of community-based behavioral healthcare services, and ambulatory EHR vendor Hello Health, according to HL7.

The CCD-to-Blue Button conversion tool is free to HL7 members. Non-members may purchase the software widget for $425.

Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)