Does healthcare need a more modern way to define and measure EHR interoperability?

For meaningful use and MACRA, the government uses an IEEE description of interoperability that pre-dates today's crop of EHRs. Whether that will carry the healthcare industry into the future, or not, is a matter of some debate. 
By Diana Manos
07:28 AM
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KLAS executive vice president Taylor Davis said that measuring interoperability can get messy because the EHR market is currently immature. 

Industry experts and the federal government are divided on the best way to assess the state of the nation’s health IT interoperability.

The Office for the National Coordinator for Health IT, for instance, has proposed using CIO surveys to gauge the status of interoperability among and between healthcare organizations.

To that end, ONC posted a Request for Information (RFI) on how to best assess interoperability that closed last month — just not before drawing some sharp comments from across the industry.

Better measures
In his response to the RFI, Gary Dickinson, director of healthcare standards at CentriHealth, said the CIO surveys won’t give a true picture of interoperability.

Dickinson, who is also co-chair of HL7’s EHR workgroup, suggested that ONC let the software tell the story, instead. EHRs aren’t currently programmed to audit how well data is transferred between EHRs or what takes place in that process.


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Dickinson speculated that health IT vendors aren’t likely to want to include this type of programming in their products, either, because it will shine a light on where interoperability is falling short.

Another problem Dickinson pointed to is that the MACRA definition of interoperability is based on an aging IEEE statement from 1990 “and that definition was never intended to describe the interoperability of health data records nor interoperation of EHR or HIT systems.”

IEEE’s definition: “The ability of two or more systems or components to exchange information and to use the information that has been exchanged.”

Because ONC in using that IEEE definition of interoperability, Dickinson said, the agency is not measuring the right things. A lot of data is lost as it is translated, and this isn’t measured in most surveys.

Dickinson said that an obvious starting point would appear to be measuring what data didn’t transmit because it had nowhere to go, and what data was successfully translated to transmit but lost elements along the way.

Measuring can get messy
Taylor Davis, executive vice president of analysis and strategy at KLAS Research, said that tuning EHRs to track interoperability would not be easy, and he bases this opinion on more than 20,000 interviews KLAS has conducted on interoperability with healthcare providers over the past few years; 500 of those took place this year.

“Measuring interoperability is messy to do,” Davis said, though he conceded that the type of auditing Dickinson suggested is possible.

“Our current research highlights that the market is incredibly immature,” Davis said. “We’re learning some common ways to send some things, but we’re still so far away.”

KLAS, in fact, formed an interoperability advisory team of providers and EHR vendors last year to create measurement standards for interoperability and plans to publish these standards in September, according to Davis.

Bigger than meaningful use
Healthcare IT News owner HIMSS and the Personal Connected Health Alliance (PCHA) commented together on ONC’s RFI that the office should consider collecting interoperability data from sources beyond those in the meaningful use program, including the data shared between patients and providers via Blue Button or Direct Messaging. Using “multiple, discrete interoperability measures” would provide “a broader, more holistic, long-term picture of the data exchange,” in addition to establishing a baseline for further study, the organizations said. 

[Also: Jonathan Bush slams meaningful use as 'incredibly dark hubris']

The DirectTrust collaborative non-profit that promotes interoperable health information exchange via the Direct message protocol, meanwhile, asked why ONC isn’t including faxes in the measurements for interoperability. Faxes are the baseline old technologies to be replaced by secure electronic exchange  – relied on perhaps by the tens of millions every day.  DirectTrust CEO David C. Kibbe suggested that it could be important to measure the quantity of faxes and their rate of replacement as a way of monitoring the progress on interoperability.

Kibbe also said the surveys ONC suggests using to measure interoperability will be a “blunt instrument,” because they don’t measure how useful the exchanged information is to providers and patients.

What clinicians actually need
Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), ONC has the job of reporting to Congress on the status of interoperability and needs to conduct appropriate research to do so.

Dickinson said he has had multiple conversations with ONC about this situation.

“We really have to get ONC out of the quantitative mode and into the qualitative mode,” Dickinson said.

How hard would it be for EHRs to have software added that could analyze interoperability in the way Dickinson suggested?

Whereas Davis said it could get tricky, Dickinson doesn’t anticipate that programming future EHRs to audit interoperability would be prohibitively expensive.

And one could argue that for EHR vendors who do it well, the capability could give them a competitive advantage.

“Clinicians want the full context of the data,” Dickinson said. “These things can be done, but nobody has requested that they be required.” 

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