Vendors, standards in the interoperability hotseat
From standards to customer demands of their vendors, interoperability advances are visible on numerous fronts. At recent conferences, these two issues were at the forefront.
Farzad Mostashari, MD, ScM, national coordinator of health IT, speaking at the CMIO Summit on Transforming Healthcare through Evidence-Based Medicine, said he heard the talk that Meaningful Use Stage 2 isn’t tough enough when it comes to interoperability. He disagrees, however. There are now 43 standards achieved through consensus. “Stage 2 is all about interoperability,” he countered. Now, providers must ask their vendors for Stage 2, not another custom interface. “Let’s be pushy customers on interoperability and exchange.”
And, he said that Office of the National Coordinator of Health IT (ONC) set the threshold low for the required use of a patient portal for now but said “that will be the foundation for patient engagement.” We can’t achieve lower costs for healthcare without the patient. “Patients are the biggest resource we have and they’re not being used.”
A perspective published in the Journal of the American Medical Informatics Association echoes Mostashari’s sentiment on vendors. “For EHRs to be truly useful and not just an electronic version of a paper chart, their design must change,” wrote Keith Marsolo, PhD, director of software development and the data warehouse at Cincinnati Children’s Hospital. “It must be easier to create data collection forms and other interfaces that are easily integrated into the clinical workflow yet are tied to underlying data elements that are common across the vendor's system.”
Vendors can do more to facilitate a developer-friendly ecosystem, but so can researchers and clinical staff responsible for EHRs. “While the informatics community needs to push for change in the design of EHRs, at the same time it needs to become more involved in their configuration and implementation,” Marsolo wrote.
On another front, getting a handle on standards should help with interoperability as well. There are lots of standards but standardization is needed for interoperability, said Amy Sheide, RN, 3M Health information services, speaking at the 84th American Health Information Management Association’s (AHIMA) Conference & Exhibition in Chicago.
Homegrown terminologies using local codes need to match more well-known vocabularies to be considered valid to meet Meaningful Use requirements. When it comes to meeting clinical quality measure objectives with standard terminologies, there are multiple values that need to be captured that live in multiple value sets and may live in multiple measures, Sheide said. “Differences between the measures are going to be observed because of inconsistent application by the measure stewards,” she said.
Plus, those discrepancies don’t capture patient data and ensure that everyone is receiving the same quality of care across organizations. It also limits the interoperability of systems especially when trying to achieve the most correct data capture.
This summer, the National Library of Medicine (NLM) and the ONC launched an aggressive effort to ensure the validity of all Meaningful Use Stage 2 value sets in collaboration with the value set authors, Sheide said.
“We’re excited about that,” said Susan Matney, MSN, RN, also with 3M, because it establishes the NLM as a single authority and a value set authority center. In the old value sets, the Meaningful Use measures were created by domain experts, but now the NLM is going to make them consistent and eventually Stage 2 compliant.
Is your organization being pushy about interoperability? Please share your experience.
Beth Walsh
Editor, Clinical Innovation + Technology
Beth Walsh
CI+T Editor
Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.