Sunday, February 26, 2012

HIMSS2012: An EHR without a HIE: Useless.

View at the infamous strip
The most important message that I took away from this year’s HIMSS meeting, amid all of the meaningful use and ICD-10 clutter, was that a EMR (or EHR) without a mechanism to share this electronic information through a Health Information Exchange (HIE), which used to be called Regional Health Information Organization (RHIO), is pretty much useless.
Yes, having an electronic equivalent of a paper chart provides the potential for decision support rules, drug-drug and drug-allergy interaction alerts, and can facilitate electronic exchange with labs, but the major benefit and potential savings comes only when information is going to be freely shared between different organizations, primary care physicians and specialists, and other healthcare providers.
A provider typically knows what drugs patients are on, and has their lab results, but what about the prescription that was written a week prior by a ER physician, or a month ago by a cardiologist? Only the exchange of this information among the different healthcare providers using some type of interchange will achieve the full potential of electronic health records.
The implementation of HIE’s is still very much in its infancy. Several speakers at this year’s HIMSS reported that there are more than 400 in place in the USA, of which about 50 percent are in the private domain, but many states have not even begun implementation. One of the issues is that, yes, there are standards in places defined by HIE on how the information to be exchanged should be encoded, but there are still too many options, different encoding possibilities and a lack of agreement on what information should be structured and how.
Exchanging information is only part of the challenge, however, another problem is that we don’t want a human person involved in  interpreting this information; rather we want the appropriate data to be interpreted, imported and integrated automatically with the local EMR.
As reported at the conference, the New York e-Health cooperative has put a stake in the ground to address this issue. Their objective is to literally create a “plug and play” connection between an EHR and HIE through the definition of requirements for patient record exchanges, patient data inquiries and exchanging clinical care documents. In the meantime, the joint interoperability work group has been expanded to date to include 14 EHR vendors, 12 HIE vendors and eight states, California, Colorado, Illinois, Kentucky, Maryland, New York, Oregon, Utah and Vermont, representing 40 percent of the US population.
Important for this activity is the alignment with the Regional Extension Center (REC) program for compliance testing and to promote those vendors that support the requirements.
The intention of this working group is to work closely with the HL7 organization so that there is a place to support and maintain this profile and allow wider implementation on a global level. In the meantime, the specifications are available on the working group website at
In conclusion, HIE connectivity is critical for EHR implementation, and this working group activity will go a long way towards achieving that.