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Interoperability and EHRs: What Physicians Need to Know

Interoperability and EHRs: What Physicians Need to Know

For physicians who are part of Atrius Health, obtaining information about patients is often as easy as pushing a button — literally.

The Massachusetts-based nonprofit alliance, which oversees six community-based medical groups and a home health and hospice agency, implemented a "Web portal button" a few years ago. Physicians who use it have nearly instant access to another participating practice's EHR, says Michael Lee, Atrius Health's director of clinical informatics and a practicing pediatrician at Dedham Medical Associates, an Atrius Health affiliate.

"That was so popular with clinicians and patients that we have now enabled that with nine hospitals in the greater Boston area, so Atrius physicians can click a button and see our patients' records," says Lee, whose organization, which includes 1,138 physicians within 58 practices, is one of CMS' 32 Pioneer accountable care organizations (ACOs). "Having this interoperable network in place helps physicians intervene more quickly, with better information, so you can make changes to change the outcome." Now physicians in three affiliated hospitals can use the same technology in the opposite direction to view Atrius' information when Atrius patients are hospitalized, he adds.

Atrius Health's push-button EHR access is one example of interoperability — a term that denotes the ability of two differing sets of technology to communicate the same language over a health information exchange (HIE). But achieving even this small level of interoperability, which is part of a bigger strategy to connect health organizations and exchange data more easily, is an ongoing and laborious effort. Here's a look at the state of interoperability and EHRs across the country, and what this means to your practice.

State of EHR interoperability

As practices seek to rein in costs and improve patient care, sharing standardized data is critical. But while proprietary networks such as Atrius Health's allow for interoperability, there is still no national, universal standard by which all certified EHRs can easily communicate.

Last year, CMS placed more stringent technology specification requirements for certified EHRs when it unveiled the requirements for the second stage of meaningful use. Now, vendors must include a Continuity of Care Document (CCD), a specification based on the HL7 language, in their upgraded EHRs. However, there is still enough room for variation in EHRs to make data within one EHR unreadable to another EHR.

"A CCD … is a standard for the 'fields' within an EHR, such as the data, such as lab requirements," says Dave Caldwell, executive vice president of Certify, a subsidiary of Humana that makes technology to connect two systems that are not natively interoperable, so that they may work in an interoperable manner. "The CCD itself has little to do with how data is communicated across two different systems. Let's say a physician goes into his EHR, and close[s] out a patient encounter. His EHR then generates a CCD and puts it into a standard data structure. But getting that CCD from his EHR system to an emergency room doctor who sees the patient the next week, is a different story."

Interoperability progress

Caldwell notes, however, that progress is being made as the healthcare industry adopts new standards for clinical data exchange known as the Integrating the Healthcare Enterprise (IHE) actors and profiles. These standards allow EHRs to understand the proper messaging protocols when serving up clinical information to a health information exchange.


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