No 'walled gardens' on the path to exchange, warns Mostashari

By Mary Mosquera
10:44 AM
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The capability to exchange health information that is structured and coded in standard format must exist across vendor products – and not just within single vendor EHRs within a large provider system – for true interoperability, says Farzad Mostashari, MD.

The national coordinator for health IT put vendors on notice that ONC will be scrutinizing the progress of interoperability in 2014 and looking toward meaningful use stage 3.

“We will pay close attention to whether the requirements in the rule are sufficient to make vendor-to-vendor exchange attainable for providers," he noted in an Aug. 28 blog post. "If there is not sufficient progress or we continue to see barriers that create data silos or ‘walled gardens,’ we will revisit our meaningful use approach and consider other options to achieve our policy intent."

Those options could include “other policies to strengthen the interoperability requirement included in meaningful use, as well as consider other regulation,” Mostashari said during an Aug. 24 webinar, sponsored by the National eHealth Collaborative, a public-private group that aims to accelerate meaningful use of health IT.

[See also: 5 Hot Topics in Healthcare Interoperability.]

In 2014, electronic health records (EHRs) will need to be able to perform a number of functions using standards that will make actual information exchange possible for transitions of care, for discharge from a hospital and for sharing with patients. Information needs to follow the patient regardless of geographical, organizational or vendor boundaries, said Mostashari.

The meaningful use Stage 2 final rule, released Aug. 23, defined the common data sets for summary of care records and detailed the measures that providers complete to be eligible for incentives.

The Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition, described the technical functions and features that vendors must incorporate in EHRs to make meaningful use possible for providers. 

"The requirements of the final rule assure that exchange occurs through ‘push’ or ‘query’ methods, while avoiding undue burden on providers and vendors to track and measure this exchange,” said Mostashari. 

“We continue to believe that vendor-to-vendor standards-based exchange being attainable for all meaningful EHR users is of paramount importance,” he said during the online presentation.

“I want there to be no question about the seriousness of our intent on this issue," said Mostashari. "The bottom line is, it’s what’s right for the patient, and it’s what we have to do as a country to get to better health, better health care and lower costs. That’s what meaningful use is all about."

Among the standards included are for outpatient lab results that will go a long way toward making sure that providers have access to structured, codified laboratory information; for public health reporting for immunizations; demographic data; and for patients to access, download and transmit to third parties their own information in human-readable and machine-readable formats.

With agreement on these and other standards, it means that “we are able to break down barriers to the electronic exchange of information and decrease the cost and complexity of building interfaces between different systems, while ensuring providers with certified electronic health record technology have the tools in place to share, understand and incorporate critical patient information,” wrote Mostashari in his blog.

To make sure EHRs can perform exchange frequently and across vendor boundaries, “we will have much more rigorous testing in our certification program,” he said, adding that “over the next few months we will release stage 2 certification test scripts criteria.” 

[See also: EHR/HIE Interoperability Workgroup agrees on connectivity specs.]

ONC will work with the National Institute of Standards and Technology (NIST) to develop a platform to test that EHRs can send, receive and incorporate standardized data using the specified standards and protocols.

“For example, it will be quite explicit around data elements for quality measures, moving to testing for interoperability, to have functional tests for interoperability instead of just conformance, and using scenarios to thread together different certification criteria,” said Mostashari.

In addition to being firm about what industry needs to accomplish for real exchange, he also pointed to the progress made in interoperability since the meaningful use Stage 1 rule was announced two years ago.

“A lot of the issues that we faced then we don’t anymore,” he said, adding that a lot of that is the result of the hard work of more than 1,000 volunteers who have engaged in activities to accelerate consensus.

“The end result of that means we can do a big push on standards-based care coordination and exchange by 2014," said Mostashari. "The country is going to be in a qualitatively different place, I believe, in 2014 when it comes to the ability to exchange information than where we are today. The switchover will begin in 2013 when these systems begin to be certified and rolled out across the country."