Frustration grows over lack of EHR standards

By Government Health IT Staff
10:02 AM

The adoption of Electronic Health Records (EHR) is being held up by a lack of standards that would allow different groups to use health care information in an efficient and effective way.

Frustration at the slow progress of EHRs was brought out at a recent Senate hearing, where the Health, Education, Labor and Pensions have been conducting hearings to find legislative improvements in EHR adoption.

Several witnesses blamed the vendor community, saying the industry needs more harmonization to ensure that privacy and security features hold consistent from one system to the next, and, crucially, that the various EHR products are interoperable, according to CIO Magazine.

"This is very hard, and that's why we believe that standards would be incredibly helpful,' says Maryl Moss, chief operating officer at Coastal Medical in Providence, R.I. "We have other work to do. We have to change the care we deliver for our patients. We really don't want to spend time deciding what vendor we're going to use."

The federal government also has to shoulder blame due to divergent reporting requirements for quality measures in place at different agencies, Moss added.

Senators were angry at reports of vendors establishing proprietary standards that effectively turn their medical records into walled gardens, undermining interoperability by design.

"It's criminal that these things aren't interoperable," said Al Franken (D-Minn.).

The Office of the National Coordinator for Health Information Technology, for its part, published a notice in the Federal Register aimed at streamlining EHR certification.

ONC’s announcement provides an opportunity for developers, health IT companies, or even private entities to submit test procedures, test tools, and test data to be considered for approved use as part of the ONC Health IT Certification Program, wrote Capt. Alicia Morton, director of ONC’s Health IT Certification Program , and Tricia Lee Wilkins, in a July 6 blog on HealthITBuzz.

"The notice was published in response to health care industry stakeholder feedback telling us that certain testing efficiencies could be achieved if the Certification Program were to include the approval of industry-led testing and certification, such as the ePrescribing (eRX) network testing (and certification)," the authors wrote.

And the American Hospital Association (AHA) has formed the Interoperability Advisory Group (IAG) to better understand member prior¬ities for information sharing, barriers to interop¬erability and specific actions that the public and private sectors could take to move forward.

The group has issued a report, titled "Achieving Interoperability That Supports Care Transformation," that identifies and addresses multiple barriers to interoperability.

IAG was composed of 24 members from a range of healthcare facilities and included information technology, clinical and administrative leaders.

The group set two priorities for information sharing. The IAG emphasized the need to focus on ensuring the efficient and effec¬tive gathering, sharing and use of health information to both support care and patient engagement, and support new models of care.

The group identified multiple barriers to interoperability, falling into three categories: insufficient infrastructure, technology challenges and unresolved policy issues.

AHA's report recommended several actions to improve interoperability, beginning with health systems identifying priorities and making those clear to vendors, who must then take steps to improve interoperability by supporting those priorities. The federal government must emphasize standards, certification and testing, while state governments should be discouraged from establishing unique requirements. 

"Achieving the vision of health information that can be easily shared to inform care, engage patients and support new models of care will take hard work on the part of every actor," the AHA report said. "Through collaborative efforts focused on the highest priority actions, however, progress can be made."