The path toward interoperable EHRs

The ONC released a draft of this years “Interoperability Standards Advisory” (ISA) in August and the final 2017 version is scheduled for completion in December. As we prepare to ring in the third year of defining and refining standards for health information exchange, let’s recap what interoperability is, why the ISA is important, and what’s coming next.

What is interoperability?

According to HIMSS, interoperability is “the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.”

While this sounds like a great goal for healthcare more generally, interoperability refers specifically to health information systems. Interoperability means that a wide variety of EHR products can seamlessly share information.

Interoperability in healthcare aims to standardize data at three levels:

1. Foundational - allowing data exchange from one IT system to another, without requiring the system receiving the information to interpret that data
2. Structural - defining the structure, format and syntax of data exchange, so that the receiving system can interpret every field of the shared data
3. Semantic - dealing with vocabulary and how data is codified, so that texts like patient summaries can be exchanged between disparate EHR systems

Overall, the goal is for different information technology systems and software applications to seamlessly communicate, exchange data, and use the information exchanged.

Why is the ISA important?

In December the 2017 Interoperability Advisory Standard (ISA) will become the third guiding document released by Office of the National Coordinator for Health Information Technology (ONC). The first version, released in 2015, set the goal of nationwide health information interoperability between 2021-2024. Each proceeding document further defines and refines standards to get the healthcare industry closer to that goal.

In addition to providing the industry with a definitive source of standards and specifications for health information exchange, the ISA serves as a place for ongoing dialogue and debate among industry stakeholders. When more than one standard could be used to fulfill a specific interoperability need, the ISA provides a venue where industry thought leaders, vendor representatives and subject matter experts can get together to decide on the best option.

What’s next?

The Health Information Management and Systems Society (HIMSS) is one of the industry stakeholders that participates in shaping the language and scope of the final ISA, and they convened a special working group to review the 2017 draft and provide recommendations. In addition to indicating opportunities for improvement, recommendations from HIMSS hint at important directions for healthcare information technology and what role interoperability can play.

One important recommendation is to expand ISA’s scope from the clinical medical records to the domain of clinical research. Since patient data within EHRs contain valuable information for clinical research, it’s useful to develop standards that allow information to easily transfer from EHRs to clinical research platforms.

Patient generated data represents another challenge and opportunity for interoperability. Nearly 85 percent of hospitals using EHRs also provide the ability for patients to add their own data to their record, while wearable health monitors are generating huge amounts of patient-generated data. The ISA can play an important role by identifying interoperability standards for patient-generated data and helping to ensure that this new source of information finds its way into EHRs.