For this to happen, the industry needs to define the capabilities it needs, the software functionality that will make it happen and the common, open technical specifications -- not the "insular and problematic and very proprietary" ones Brown says EHR vendors have used for so long -- that can deliver these features. "If we don't specify what we need to do as these new types of [health care] delivery models, or existing delivery models, we can't expect to get a usable, interoperable IT system to support them," Waldren says.
The Cure Project is taking a grassroots approach to defining these capabilities and functionality; its parent company, New Health Networks, will license the output via Creative Commons, and once that work is finished the Cure Project will turn the work over to an entity the community deems best suited to manage and oversee the specifications.
A grassroots approach is necessary because those definitions need to be specific. For example, Waldren points out, health care leaders say they want "population management" capabilities, but that's far too vague to build specs around.
The community needs to decide what patient care quality measures need to appear in a dashboard, what evidence can be brought in to change an individual patient's care plan and, on a broader level, what data will be used to determine which patients are at the highest risk of, say, developing diabetes. If that doesn't happen, he says, the emerging EHR backlash will only worsen.
EHR interoperability struggles of VA, DoD point to management woes
Few scenarios better illustrates the difficulty of interoperability, and the source of that backlash, than the 15-year effort of the Veterans Affairs and Defense departments to get their EHR systems to talk to each other.
The departments represent two of the largest health care systems in the United States and are two of the earliest adopters of EHR technology: VistA, launched in 1978, helps the VA treats 6.3 million veterans, while the DOD's AHLTA, which debuted in 1997, holds records for 9.6 million active-duty service members.
Since the late 1990s, both Congress and the president have urged the departments to achieve varying measures of EHR interoperability. Planning has been absent virtually every step of the way, Valerie C. Melvin, director of information management and technology resources issues for the Government Accountability Office, testified before the U.S. House of Representatives Committee on Veterans' Affairs.
The testimony came after the VA and DoD first said they would abandon the effort to develop a joint EHR by 2017 and then backtracked, saying they were committed to integrated EHR systems rather than a shared system. (They've hired Harris Healthcare Solutions to build a common backbone, EHR interchange format, and common APIs to enable data exchange betwene te two systems.)
Melvin cited several examples: