The Jagged Path to Electronic Health Record Interoperability

The early vision of EHR interoperability was formulated by the first ONC head, David Brailer M.D. in 2006. It was part of a greater study on Information Technology by George W. Bush when he created ONC with an executive order.

Since that time we have had a series of ONC chiefs, each one with a different emphasis and focus on the growth of infrastructure to support health data exchanges.

Interoperatiliby is actually a misnomer, because EHRs, regardless of harmonization do not communicate with each other directly, and only contain certain data sets that can be decoded by intervening software.  There are some networked EHRs that provide true communication among multiple site using their own proprietary software. However, these are actually closed silos unless conntected to a regional health data exchange.

The extent and cost of a HDE is a function of the number of fields to be linked. The most common set is the CCR and it is also the basic standard.

Connecting two or more disparate systems is a technical challenge, however the legalese and bureaucracy are also challenged by state regulations.  Trust agreements are a necessity to ensure security and privacy as well. Networks that cross state lines present a special set of challenges.

Economic stability for the HDE is a critical ingredient, and that may vary greatly according to region. The most challenging cases are those connecting multiple small institutions, small hospitals and medical groups.  Large institutions and metropolitan areas have the financial strength to invest in HDEs.

In order to qualify for certain Federal incentives the HDE must contain functions such as secure portals, messaging, all in accord with HIPAA regulation.

Fast forward to 2015

ONC's Karen DeSalvo outlines 3 steps to interoperability

National Coordinator for Health IT Karen DeSalvo continues to tout "the bright future" of health IT, outlining in a post atHealth Affairs what needs to be done to get to full interoperability.

Her steps to getting to interoperability include:

1. Standardizing application programming interfaces and implementation standards.
2. Creating clarity around the environment of trust. "What are the shared expectations and actions around data security and privacy?" she asks.
3. Providing incentives for interoperability and the appropriate uses of electronic health information.

However, she also writes about the problems states still face when it comes to adoption. In Alabama, for example, providers face a lack of broadband access in undeserved communities. In New Jersey differing privacy laws in neighboring states are a barrier to information exchange, she writes.

 We will need an unprecedented amount of cooperation, collaboration, and transparency to see that there is the best public private partnership possible .…

Her undaunted cry is:

 "We will need an unprecedented amount of cooperation, collaboration, and transparency to see that there is the best public private partnership possible" .…creates the challenge to all vendors, state and federal entities and cooperation at the local  to achieve.