Electronic health records have made the journey from futuristic technology to common tools of the modern physician. From large health networks to independent practices, EHRs are no longer just a way to appease federal reimbursement requirements. Now, they are necessary to achieve the highest possible level of clinical care.

However, that next-generation of EHR interoperability has eluded many providers, as recording and storing patient health information has proven much easier than mobilizing and transmitting it to other clinicians who interact with the same patients. Interoperable EHR systems have been bandied about as the apex of the digital health revolution, but as is often the case in large-scale reforms of major industries, buzzwords can dominate the discussion more than substantive talks about what needs to be done. While “interoperability” has been on the tongues of industry leaders for years, what does it truly mean to have an EHR system capable of transmitting secure PHI?

According to a study published in the Journal of the American Medical Informatics Association, rather than looking at EHR interoperability as a vague concept in advancing health IT, five key areas can define actionable use of the EHRs in ways that promote data sharing for patients and other clinicians alike.

What are the key elements of an interoperable EHR system?"What are the key elements of an interoperable EHR system?”

EHRs the ‘EXTREME’ way

One of the more difficult concepts about EHR interoperability is the need to keep data secure while avoiding any practices that hamper access to qualified clinicians and patients. However, determining that line has proven difficult in the past, which is why two health IT researchers have dug into successful cases of EHR interoperability to examine key elements of smooth implementation.

Dean Sittig, Ph.D., professor of biomedical informatics at the University of Texas Health Science Center at Houston, and Adam Wright, Ph.D., medical informatics researcher at Boston’s Brigham and Women’s Hospital, examined a number of cases where providers successfully integrated a fully functional interoperable EHR into their workflows. In the JAMIA study, they used the term “EXTREME” to break down the five key areas that all practices must focus on:

  • Extract: PHI needs to be safely extracted from a larger EHR while preserving the integrity of the overall file structure.
  • Transmit: While conserving file structure, individual clinicians need to be able to transmit PHI to colleagues regardless of the system being used on the other end.
  • Exchange: Aside from user-initiated transmission protocols, providers in health information exchanges need to operate in similar fashions when sent automated requests for patient data.
  • Move: Existing PHI needs to be fully compatible if the practice decides to upgrade to a different EHR system from a new vendor.
  • Embed: Through the use of an application programming interface, PHI can be manipulated and stored within the EHR itself.

“Clinicians sharing data and researchers looking for relevant PHI need equal access.”

Sittig and Wright explained that the EXTREME methodology creates areas where every member of the EHR ecosystem can interact with contained data without jumping through unnecessary hoops. Clinicians sharing data with off-site radiologists and researchers looking for relevant PHI should have equal, yet guarded, access in truly interoperable EHRs.

“Healthcare delivery organizations should require these capabilities in their EHRs,” Sittig explained in a statement to Healthcare IT News. “EHR developers should commit to providing them. Health care organizations should commit to implementing and using them. In addition to having all EHRs meet these technical requirements, we must also begin addressing the myriad socio-legal barriers to widespread health information exchange that is required to transform the modern EHR-enabled health care delivery system.”

A long road

With so much on their plates already, small practices might look at the incredible number of interests they have to placate in the EHR interoperability process and simply throw their hands up. However, as Dr. David Kibbe, senior advisor for the American Academy of Family Physicians, explained during recent testimony to the Senate Committee on Health Education, Labor and Pensions, the current hard path may be preferable to what else is out there.

“Healthcare provider organizations must come to realize that acting in the best interest of patients is to assure that health information follows the patient and consumer to whatever setting will provide treatment, even if that means in a competitor’s hospital or medical practice,” Kibbe said, as quoted by Health IT Analytics.  “And they must demand collaborative and interoperable health IT tools from their EHR vendors to make this routine and ubiquitous as a practice in every community in the U.S.”