Hurdles and Solutions for the Interoperable EHR

John W, Loonsk, MD FACMIChief Medical Officer CGI

• Issues with the availability of definitive and detailed standards– Standards are necessary, but not sufficient for interoperability– Best way to advance standards is to have many people using them

• Other challenges to interoperability:– Few incentives for exchanging information

• When “value” of exchanging is high it costs to not be interoperable

– Many incentives for not exchanging information• Propriety business needs• Tacit “ownership”• Integration services profits• Existing non standards-based systems• Patient confidentiality issues• HIPAA and other legal angst• Subpoena concerns

Interoperability

• Data standards– Text and viewing– Terminologies and value sets– Metadata and XML “bins”

• Technical standards– Queries, routing of information, security– Relationship to architecture

• Combinations of data, metadata and technical standards– Implementation guidance / specifications– Transactions

Types of Standards

Dependencies - from Outcome to Initiation

• Testable interoperability– Identified data and technical standards– Detailed specifications– Testing infrastructure

• Identified standards and specifications– Valid process for identifying “named” standards– Well maintained, implementation level guidance

• Accepted process for identifying standards– Context for standards use– Multi-stakeholder process

• Value and context for standards use– Business value in information exchange– Alignment with broader agenda

Testing

Challenges for testing– Need to test

• Terminology value sets• Messages / documents• Web services• Transport• Security

– On-site implementation and testing– Multiple, connected business processes– Multiple participants and “one to many” interoperability– Errors and error handling– Technical tools to achieve

A Nationwide Health Information Network

Labs

Pharmacies

Community Health Centers

State and Local Gov

HealthBank

CDC

Geo HIERHIO

DoD

SSA

CMS

VA

PCHR SupportOrganization

Common “dial tone” and “chain of trust”

PHRHIE

FedHIE

HIE

IDSHIE

FDA

Building Network Standards

Patient lookup and Information

retrieval

Provision of electronic data

for reporting and other uses

Information routing and delivery

(including summary patient records)

Exchange of Consumer

Preferences

Common Access to Health

Organizations

Federated Information

Management

Transitions in CareTransitions in Care

Quality Reporting

Quality Reporting

Results Delivery

Results Delivery

Personal Health Records

Personal Health Records

ePrescribingePrescribing

Lab Result Delivery

Lab Result Delivery

BiosurveillanceBiosurveillance

Other Priority Initiatives

Other Priority Initiatives

Reusable infrastructure for health initiativesNetwork

Services

Capabilities

FunctionalNeeds

Distributed Query

Support

Solutions

• Ensure value in information exchange

• Have unambiguous and detailed specifications

• Have very specific technical testing to ensure implementation and ease development

• Have a “reference implementation” of the standards for use

• Develop a community of use