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The Evolution of EMR Standards
May 2006
Every 15 minutes, a computer program at Beth Israel Deaconess Medical Center in Boston collects specified data from various information systems, formats it and securely transmits the data to computer systems at the U.S. Centers for Disease Control and Prevention.
The transmitted patient data includes gender, age, ZIP code and chief complaint. The hospital is one of a small number in the nation now sending near real-time data to CDC as part of the government's BioSense biosurveillance initiative. The idea behind BioSense, which the government hopes to expand nationwide, is to identify in its earliest stage a bioterrorism attack or natural disease outbreak, such as bird flu.
Beth Israel collects the data from disparate systems in a Cache database from Cambridge, Mass.-based InterSystems Corp. and sends it in a data stream using CDC middleware and version 2.4 of the Health Level Seven standards for electronic clinical messaging. "Data standards are absolutely critical for interoperability," says John Halamka, M.D., CIO at CareGroup Healthcare System in Boston, a four-hospital delivery system that includes Beth Israel.
As providers increasingly adopt electronic medical records systems, the ability of those systems to interoperate will decide the fate of a national health information network.
But there is a dizzying array of data standards designed to ensure EMR interoperability (see chart, page 56), with new standards being developed (see story, page 52).
Most standards development organizations are well-established and have worked together for many years. But as the industry finds needs for new standards in the search for interoperable EMRs, a traffic cop is needed to ensure cooperation continues.
In the absence of federal mandates to use clinical data standards, the industry is developing a software certification program so market forces will compel software vendors to offer functional, secure and interoperable products.
The work of the Certification Commission for Healthcare Information Technology is important because to be certified, vendors' products must-among other factors-support a comprehensive suite of data standards. "The hope is the market will say, 'Yes, we will buy those products that are certified because they clearly are interoperable,'" Halamka says.
The commission this year is finalizing criteria for its first project-ambulatory EMRs-with work on inpatient EMR certification starting soon.
More information on the industry-sponsored commission, now working under a federal contract, is available at www.cchit.org.
Staying on page
Understanding the different types of standards and how they enable interoperability is a challenge for providers and software vendors.
But getting the standards to harmonize-or complement each other with little overlap-also will be a major challenge. "I don't think health care can afford competing standards if we want to move to interoperability in our lifetimes," says Barry Chaiken, M.D., associate chief medical officer at BearingPoint Inc., a McLean, Va.-based consulting firm.
Much of the task of harmonizing standards will fall on the Health Information Technology Standards Panel, a consortium of industry stakeholders.
Under a contract with the federal government, HITSP will seek to be the facilitator that helps standards development organizations identify priority needs and work together. The contract with the Department of Health and Human Services means the government has endorsed its work as important. But the panel also will identify and adopt certain standards for I.T. initiatives that include government involvement.
For instance, an immediate goal of the panel this year is to create implementation guides for standards necessary for the government's "breakthrough projects."
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