Study finds Stage 2 EHRs not ready for data sharing

Despite the efforts toward interoperabiity, the current architecture for data exchange required by Meaningful Use Stage 2 does not allow for "robust" patient data sharing, according to a study published in the Journal of the American Informatics Association (JAMIA).

Researchers from the Office of the National Coordinator for Health IT-funded Substitutable Medical Applications and Reusable Technology (SMART) C-CDA Collaborative evaluated the Consolidated Clinical Document Architecture (C-CDA) for document exchange. EHRs must produce C-CDA documents to meet MU Stage 2 but the researchers found 11 areas of errors and variability that create barriers to interoperability.

In 91 C-CDA sample documents representing 21 distinct technologies from 107 health IT organizations, the common "trouble spots" included omission or misuse of allergic reactions, omission of dose frequency and omission of results in interpretation. Some problems, however, can't be detected automatically. The researchers "frequently observed variations where the C-CDA specification does not provide uniform guidance." For example, they found 12 distinct patterns for recording a telephone number when factoring in dashes, parentheses, etc. "These representations are straightforward for humans to interpret but automated tools require specificity on permissible representations."

Progress has been made since Stage 1, they wrote, but "any expectation that C-CDA documents could provide complete and consistently structured patient data is premature. Based on the scope of errors and heterogeneity observed, C-CDA documents produced from technologies in Stage 2 of MU will omit key clinical information and often require manual data reconciliation during exchange."

While the researchers offered recommendations to improve interoperability, such as providing richer, more standardized samples in public accessible format, reduction of data optionality, validation of codes and vocabulary, "without timely policy to move these elements forward, semantically robust document exchange will not happen anytime soon."

Read the complete study.