HIE: Seals of approval
This spring, the Certification Commission for Health Information Technology is launching the pilot phase of its new health information exchange compliance-testing program.
The program is jointly led by the EHR/HIE Interoperability Workgroup, a partnership of states and vendors convened by the New York eHealth Collaborative (NYeC), and Healtheway, which runs the eHealth exchange, formerly known as the Nationwide Health Information Network.
"The mission we're trying to get to is being plug-and-play," says Anuj Desai, NYeC's vice president for market development.
Toward that end, the certification program developed three different seals, designed to offer providers assurance that a given technology is certified for exchange.
The "HIE Certified Community" seal for electronic health records will enable statewide patient data inquiry, assuring that clinicians can query an HIE for information on specific patients. The "HIE Certified Direct" designation ensures that a system offers a simple way to send secure health data directly to trusted recipients, including patients, using Direct Project protocols. And the "HIE Certified Network" is an imprimatur that promises connection to the eHealth Exchange.
Upon seeing these seals, "a provider, when they're buying an EMR, can know it has all the components required to connect seamlessly," says Desai.
The pilot testing for the HIE Certified Network designation - a collaboration of states, public agencies, federally funded HIEs and vendors - covers more than half of the U.S. population, officials say. Upon its completion, the official launch of the certification program is planned for late in the spring.
This project has its roots in New York.
"We saw in our state, where we have 11 small HIEs, that one HIE didn't have enough leveraging power with the vendor community to drive toward consistent implementation standards," says Desai. "There are many standards out there. A lot of optionality around what you can do. And what that represents for providers is a high cost to connect to the HIE and drive coordinated care."
So NYeC convened the interoperability workgroup a couple years ago, joining with other states and the vendors to work collaboratively toward some tangible goals: "What can we achieve in a year's time frame, as opposed to a pie-in-the-sky nirvana that may have never taken root."
The result? Nineteen states, representing 52 percent of the population, and 42 EHR and HIE vendors have signed on, committed to developing their products to meet those interoperability standards.
"Vendors didn't need any convincing," says Desai. "We spoke to the C-suite level and the heads of interoperability. The challenge the vendors are having, we're finding, is that they're being asked to do so many interfaces. Every time a connection is made, it's a custom connection.
"What they're saying to us is, 'Come together, collectively as states, tell us what you want, and we'll build it once.' That's the value proposition. It's no problem getting them on board."
The same challenges in a state like New York exist on a nationwide scale, of course, says says Mariann Yeager, interim executive director of Healtheway. "Since we're supporting a community of 39 different organizations, who share data across 50 states, with 20 different technology solutions, much like the EHR-HIE interoperability workgroup, there's a similar need.
"We needed a very robust, automated, efficient, testing and on-boarding process, because we simply can't afford to do one-off testing and be a business," she adds. "We're a non-profit. It would be exorbitant to try to scale that to the level of connectivity that we have. Today we connect 700 hospitals, 5,000 physician practices more than 15,000 clinicians, across more than 100 million patients."
Add to that the fact that Healtheway recently joined up with the Care Connectivity Consortium (Kaiser Permanente, Geisinger Health System, Mayo Clinic, Intermountain Healthcare and Group Health Cooperative) and it's clear that "the sheer scale of what we're talking about is equivalent of what the EHR-HIE Interoperability workgroup was doing," says Yeager.
"Last year at HIMSS12 we sat here and realized we had the same vision, the same need. But rather than having two different certification and testing programs, let's work together and harmonize technical specs."
That's where CCHIT comes in, says Alisa Ray, the commission's executive director and CEO.
"When they formed the partnership, they saw the value of having an independent third-party," she says. "We're really good at testing and certification, right? That's what we do."
CCHIT recently partnered with Aegis to develop an automated tool for compliance testing called the Developers Integration Lab. Vendors can practice with it, see that the messages and queries are going through and working correctly.
"We believe we'll be able to open and start taking applications later in the spring," says Ray. "So this should be something people should be able to see really soon: vendors with the seal."
"One of the things I've heard that the vendors are really excited about, the deal allows them to self-test first," says Desai. "They can actually log in and see what tests they'll be able to pass, and what areas they're going to need to work on."
"To give you a level of comparison, when eHealth exchange was supported by ONC process, at that time it was largely manual - testing and on-boarding took weeks, sometimes months," says Yeager. "It was hard. The great news is we were able to learn from that. And that actually informed our specifications."
The aim of all this activity, of course, is to get physicians to link up, to convince them that they too can exchange data with minimal hassle - almost as simple as flipping a switch.
"One of the challenges we have in New York is that we have great adoption by hospitals, but the small physician practices are connecting via a portal, so it's not integrated with their workflow," says Desai. "We want HIE to be fully integrated into the workflow, and we want assurance that the EHRs they're buying are connected to the HIE seamlessly. You need that for coordinated care."
"If we're successful, the joint vision is that providers can test to their HIEs, and HIEs can connect to each other," says Yeager. "Then we have interconnected care across the country, and it's ubiquitous. Without customized interfaces. And then we truly, truly have nationwide exchange. It's that simple."