EHRs require EXTREME--use cases for interoperability

EHRs need five "use cases" to be considered "open" or interoperable, according to an article in the Journal of the American Medical Informatics Association (JAMIA).

Authored by Dean Sittig, PhD, professor at the University Texas Memorial Hermann Center for Health Care Quality and Safety, and Adam Wright, PhD, medical informaticist at Boston's Brigham and Women's Hospital, the article says the following five functionalities are important to move to EHRs more globally: to EXtract, TRansmit, Exchange, Move and Embed data (EXTREME). The authors identify requirements for each use, such as infrastructure that can respond to queries around the clock, the ability to preserve metadata when moving data and secure log in and role-based access controls.

"Widespread access to 'open EHRs' that conform to at least the five EXTREME use cases we propose is necessary if we are to realize the enormous potential of an EHR-enabled healthcare system," Sittig and Wright wrote. "Healthcare delivery organizations should require these capabilities in their EHRs. EHR developers should commit to providing them. Healthcare organizations should commit to implementing and using them."

They also said the healthcare community must address the socio-legal barriers to the widespread health information exchange required to transform the modern EHR-enabled healthcare delivery system.

Sittig and Wright recommended stringent testing of EHRs to ensure receiving systems can import, parse and store the data. They also question current constraints to open and interoperable systems, such as training by EHR developers, nondisclosure contracts, the imposition of additional fees to access data and customized programming that only a developer can do.  

Read the article.