EHR vendors are actively tackling interoperability, according to a survey
conducted by the HIMSS Electronic Health Record Vendors Association
(EHRVA), and the group’s co-chair, Hugh Zettel, says progress is being made, though more needs to be done. Zettel is director of government and industry relations at GE Healthcare Integrated IT Solutions
. He recently spoke with Digital HealthCare & Productivity
about the interoperability roadmap ahead.
DHP: The EHRVA survey indicates vendors understand HITSP’s (Health Information Technology Standards Panel) specifications and plan to incorporate them into product development. Would you say the industry is making good progress?
Zettel: We’re starting to see the fruits of our efforts show up in production products. The fact that HITSP came at it from AHIC (American Health Information Community) use-cases’ [perspective] means we have a top-down nationwide health information structure. But we’re finding that many integrated hospital delivery systems that want interoperability solutions aren’t yet ready to participate in a RHIO (regional health information organization). They want to provide improved services in an outpatient setting. In order to do that, we must find a way to show them how to do that through an integrated healthcare enterprise. We need to show them how to build out the IDM (interactive domain model), and when the RHIO comes to their neighborhood, they can scale up and plug into that.
DHP: EHRVA has been working with CCHIT (Certification Commission for Healthcare Information Technology.) What’s going on with that dialogue?
Zettel: There’s always some tension between CCHIT and us, balancing what they need to do while still taking advice from vendors and recognizing the valuable feedback provided on behalf of customers. We recognize certification is here and it could be a great enabler for adoption, but we want to make sure it’s a positive enabler. There are things going on with certification that make the marketplace less competitive than in the past. We want to make sure the marketplace remains vibrant.
There’s a huge amount of information out there and as an organization we’re overwhelmed. It will be interesting to see whether CCHIT can get the requirements done in time. The area we are focusing on is making sure they have meaningful interoperability requirements. We want to make sure that the interoperability solutions meet the bread-and-butter needs of the inpatient and ambulatory settings.
DHP: What’s an example of this?
Zettel: You have a lot of niche EMR (electronic medical record) providers that offer specific specialty solutions, such as those for the ob-gyn markets. But this is not on top of the list for CCHIT to provide certification for, so we should have a way for them to participate until the time has come that CCHIT has addressed this and other specialties.
I think what’s going to be interesting in the next round of certification efforts, or as interoperability progresses, is increasing the recognition by clinicians that they need to use these types of solutions. We’ve made a lot of progress getting on the same page but there isn’t enough incentive yet in the provider space to use these solutions.
DHP: But interoperability is possible?
Zettel: It’s possible to have open, standards-based data exchange with other vendors. The earliest example is the Digital Imaging and Communications in Medicine (DICOM) standard, which enabled diagnostic imaging devices and software systems to exchange images and other information regardless of vendor. The lesson of DICOM is that market pressure to demand interoperability of [health information technology] is more effective than regulatory remedies.
We’re trying to do the same thing on the clinical side, but it’s challenging because standards for EMRs are complex and involve multiple types of data and technologies. Our roadmap contemplates that interoperability will be achieved incrementally, and while technical solutions supporting data exchange is critical, there is only so much vendors can do. Providers may be reluctant to participate for fear of losing their edge in a fiercely competitive marketplace. That’s why it’s critical that all stakeholders work together to try to put into place creative solutions that create market demand for interoperability.
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