Vendor Selection Criteria: Interoperability

Interoperability

When selecting a vendor for EHR implementation, interoperability or functionality should be considered. In a 2015 publication, "What makes an EHR "open" or interoperable?" there were five cases where interoperability should be considered when selecting an EHR. The following should be considered:

• Clinicians- essential to provide safe and effective care
• Researchers- critical to advance and understand disease processes
• Administrators - to reduce the dependence on one EHR vendor
• Software developers- to develop interface and software
• Patients- important to access personal health information

Widespread access to EHR information is important if the full potential of the electronic health care system is to be realized.

The purpose of EHR is to provide access of patient information to the right people at the right time. Interoperability is the ability to exchange this information between different EHR systems and stakeholders. There are standards considered by the Health IT. These standards are divided into 3 different categories: content, terminology and transport.

Importance of Interoperability

Interoperability is of significant importance for multiple reasons:

• Security: low standards of interoperability can lead to security hazards
• Behavior change in patient health habits may be affected
• Interactions between multiple branches of systems in the health industry depend on the interoperabilty of systems

Interoperability Considerations

It is important to determine prior to selecting a vendor what type of data and devices a facility needs to exchange information.

• PACS Systems
• Medical Devices (Monitors, Ventilators, Anesthesia cart, etc.)
• Pharmacy
• Laboratory Orders and Results
• Critical Values Reporting
• Electronic Health Records to other facilities and/or physician's practices

EMR needs to have interoperability specifications

• Defined levels and mechanisms of desired semantic interoperability
• Well-defined architecture and modularized interfaces to build transition plans for future upgrades
• Patient data safety

Ensure that Information Technology, Biomed and EMR vendor are engaged in all conversations to achieve desired interoperability level.

Content Standards

• The content standards consist of XML, HL7, CDA and DICOM.

There are mainly two types of contents in clinical data; 1. Structured Data, which is computationally tractable and used in Billing, Lab reports, problem lists and others and 2. Unstructured Data, which is usually physician dictations that is free text, this is not computationally tractable and requires Natural Language Processing. Data extractors likes cTAKES, METAMAP and MEDLEE are used to process free texts.

Terminology Standards

• The terminology standards consist of LOINC, RxNorm, SNOMED and MEDCIN.

"MEDCIN is a clinical terminology designed to support medical documentation entry into electronic health record systems. MEDCIN was initially developed as “an intelligent clinical database for documentation at the time of care.”(16) MEDCIN's producer, Medicomp, states that their software “makes capture of the encounter information fast enough, sufficiently comprehensive and rewarding to overcome physician reluctance.” MEDCIN has evolved to include more than 250,000 concepts since 1978, and has been installed in several EHR systems as an interface terminology for clinical documentation including AHLTA, the EHR system developed for the US Department of Defense." (Brown et al. 2007)

Transport Standards

• The transport standards consist of ELINCS, IEEE 11073, NCPDP and ASC X12.

ELINCS stands for EHR-LAB Interoperability and Connectivity Standards enables messaging between laboratory and clinicians ambulatory EHRs, IEEE 11073 is the transport standard for medical device connectivity and data exchange, National Council for Prescription Drug Program (NCPDP) is for the exchange of prescription related information and Accredited standards Committee (ASC)X12 is for electronic data interchange or computer-computer business data exchange. Other transport standards include Script (V10.10) for physician pharmacist communication, OpenID Connect helps web-based, mobile to connect to an authentication server and IHE-PCD based on IEEE integrates the healthcare enterprise and patient care device.

2015 Interoperability Standards Advisory

On January 30, 2015, the ONC released a document entitled “2015 Interoperability Standards Advisory.” It is essentially a document noting many standards that are recommended for interoperability among EHRs. There are criteria for content standards, structure standards, and transport standards, among other notable standards for interoperability. The document is subject to change as the ONC moves forward and also contains a section noting how changes to the document will take place.