How Stage 2 Meaningful Use impacts EMR/EHR interoperability

Sam Shapiro, Qvera

Sam Shapiro, President, Chief Executive Officer, Qvera

Meaningful Use Stage 2 (MU2) introduced a new set of interoperability challenges for physician practices; ambulatory care medical offices and electronic health record (EHR) software platform vendors. MU2 significantly expanded interoperability requirements, adding several new core measures such as ongoing submission of immunization data to the state immunization registries and Core Measure 15 that requires that 10 percent of patient referrals be sent electronically. This measure alone introduced both a new document type requirement (the C-CDA summary of care record) as well as a new data transmission requirement (the NwHIN Exchange). These requirements are not trivial and can come at a significant cost.

With these expanded MU2 interoperability requirements, EHR vendors have recognized the need to partner with interface engine technology companies. Qvera has partnered with several EHR vendors including HealthTronics, a provider of urology specific EHR systems. Following years of using homegrown and open-source interface engines, HealthTronics selected and standardized on the Qvera Interface Engine (QIE) as they required a highly scalable interface engine platform, capable of very large message volumes for their hosted environments. HealthTronics knew the MU2 interoperability requirements demanded more than what their existing tools could provide.

As an interface engine company at the forefront of interoperability, we have a unique perspective on the challenges that provider organizations face in meeting Meaningful Use interoperability requirements. Qvera works closely with organizations that span the full spectrum of healthcare. Large integrated delivery networks and independent physician offices are working hard to attest for Meaningful Use. We have seen first-hand how making interoperability happen in the real world requires much more than just Certified EHR Technology. Getting to the all-important ‘go-live’ milestone is a coordinated effort involving multiple organizations and IT vendors. And while the Meaningful Use initiative has made a significant impact in the adoption and implementation of interoperability standards across the industry, the existing standards are complex and there is a lot of wiggle room when interpreting the standards. This causes problems when conflicting interpretations of the standards meet in the real world. Having interface engine tools and technologies that are simple, flexible and intuitive to use goes a long ways towards bridging these interpretation gaps. And for smaller independent physician offices that don’t have the resources that large integrated delivery networks have, having the right interface engine tools can mean the difference between success and failure when it comes to Meaningful Use Attestation.

Another challenge lies with the fact that for the most part, the networks and protocols being utilized for data transport are relatively new and adoption has been slow. Both our vendor partners and their end-user customers have experienced the frustration of getting their IT software systems in place to send and receive transition of care referrals only to find that their referral partners on the other end of the transmission are not yet ready. It’s akin to setting up your first Facebook account and not having anyone to ‘friend’.

For example, as HealthTronics began rolling out their own MU2 enabled solutions they too found that the blocking issue was not the lack of technology in their own solution, but rather the overall readiness among all the players in their interconnected community. Slowly it is all coming together, and on the bright side it is apparent that these Stage 2 measures are proving to be a forcing function to bring healthcare further into the age of true interoperability.

One key to facilitating long-term interoperability success is simplifying the data standards and transport protocols. The current standards utilized in the MU2 interoperability requirements are far too complex and this complexity slows adoption and drives up costs. The industry recognizes this and is currently developing new standards focused on removing complexity and simplifying the standards. Qvera participated this year in the IHE New Directions program held in conjunction with the IHE’s North American Connectathon in Cleveland Ohio. The New Directions event focused this year on testing and validating the emerging Cross Enterprise Document Sharing (XDS) system of standards for sharing patient records using the Fast Healthcare Interoperability Resources (FHIR) – a specification that simplifies mobile access to healthcare information. The FHIR standard is expected to move into trial implementation later this year. As standards like FHIR that simplify and streamline interoperability are adopted, costs will go down and interoperability will go up.

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