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Are PHRs the key to interoperability?
By: Mark Kaufmann, MD
Mark D. Kaufmann, MD is an associate Clinical Professor of Dermatology, Dept. of Dermatology at the Icahn School of Medicine at Mount Sinai in New York City, and the author of Digital Practice, a monthly column in Practical Dermatology® magazine.
Interoperability has long been considered the Holy Grail of health information technology, and it has seemed just as elusive at times, but we may be closer to achieving this goal than previously believed. (The key word here is may.)
Interoperability is the extent to which systems and devices can exchange data, and interpret that shared data, according to the Healthcare Information and Management Systems Society (HIMSS). The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, focuses on “interoperability” of electronic health records (EHRs) software and systems. The recently signed 21st Century Cures Act also encourages interoperability of EHRs and patient access to health data. “Cures” also requires vendors to demonstrate that they are not blocking information or in any way inhibiting data transfer and must also utilize application programming interfaces (APIs) or a similar data transfer enabling technology.
State of the Industry
As it stands today, almost all hospitals now have a certified EHR, and the shift to value-based care is happening.
“The healthcare information technology sector is getting incrementally closer to interoperability, with companies devoted entirely to bridging between different EHR systems, like Redox and Mirth,” says plastic surgeon Tim A. Sayed, MD, MBA, FACS, Vice President of Physician Engagement at Interpreta, Inc. in San Diego. “These allow data exchange through Health Level 7 (HL-7) interfaces between different EHR data formats.” HL-7 was developed specifically for the healthcare industry to connect legacy systems by using a standard messaging protocol.
“However, that does not make the exchange of the data a frictionless experience for the providers or patients,” says Dr. Sayed, who also served as the medical director of Modernizing Medicine’s Electronic Medical Assistant® (EMA™) plastic surgery. “It also does not really make them more usable from a user experience standpoint.”
Focusing on Patients
In the past, interoperability tended to center around sharing among doctors, pharmacies, and medical systems, but newer iterations aim to put the power back in the patient’s hands, and this may be the ticket. There is a groundswell of activity at some larger hospitals and start-ups that seeks to make the patient the master of their (healthcare data) domain—with patient health records (PHR). In this scenario, all of a patient’s health information is kept in a secure, central repository, and the patient can then send their doctor a link before an upcoming visit. The physician could then pull in all previous skin biopsies and blood tests, for example, and have all relevant health information at his or her fingertips. This will save healthcare costs by eliminating repeated or unnecessary testing.
A lot needs to happen for this vision to become a reality. A company will need to find ways to include every vendor and every healthcare system. One such company, Mericom, is now trying to raise funds via crowdfunding platform kickstarter with the lofty goal of developing a system integrates with all major electronic medical record systems and follows patients wherever they go.
The Department of Health and Humans Services’ Office of the National Coordinator for Health Information Technology (ONC) Move Health Data Forward Challenge also seeks to push the PHR needle forward. Recently, five companies were named Phase 2 winners of this challenge, and will now move on to Phase 3 —the development of applications that will allow individuals to share their personal health information safely and securely with their healthcare providers, family members, or other caregivers. The finalists include CedarBridge Group LLC’s CareApprove™ app, which allows patients to grant—and revoke—permission for providers to access, send, or receive health information electronically; EMR Direct’s The HealthToGo, which facilitates the deployment of applications capable of leveraging multiple data sources in a consumer-mediated health data exchange; Foxhall Wythe LLC: Docket™, an app that allows users to seamlessly store and share data with care professionals, eliminating the need for paper-based intakes; Live and Leave Well™ that provides both a consumer mediated exchange of end of life plan, and Lush Group, Inc.’ s The HealthyMePHR system that gives patients the the ability to share, and authorize access to, their EHR.
One recent noteworthy and somewhat under-the-radar event was the acquisition of Gliimpse by Apple, Dr. Sayed says. “Gliimpse is a medical record sharing cloud service that purports to be a user-friendly bridge between different medical record systems and a direct-to-consumer product.”
Meeting of the Minds
There has been some other activity on the interoperability front as well. The CommonWell Health Alliance is working to create a vendor-neutral platform. Allscripts, athenahealth, Cerner, Evident (then known as CPSI), Greenway Health, McKesson, and Sunquest created this vendor-led organization, which now has 60-plus member companies and more than 9800+ provider sites. Athenahealth, Epic, eClinicalWorks, NextGen Healthcare, and Surescripts all signed on to implement Carequality’s framework for interoperability and data sharing principles, and now the two powerhouses are working together. This is what we call progress.
“Historically, the EHR vendors have been somewhat reluctant to engage in interoperability, as they—mistakenly in my opinion—believe that their data formats are true intellectual property,” Dr. Sayed says. “Under significant pressure, several EHR vendors have come together in alliances like CommonWell to try to foster a more open environment for record exchange.”
Are we there yet? No, but I think it is fair to say that we are edging closer to “interoperability” in some form or another. Stay tuned.