Study reveals lack of interoperability between certified EHR systems

As part of the digital revolution of the past 20 years, electronic health records are meant to enhance interoffice communications between hospitals, general practitioners and other health care specialists. However, a recent study in the Journal of the American Medical Informatics Association indicates that some EHR systems that were certified under stage 2 of meaningful use are not compatible with other EHR software. This represents a significant problem since the Centers for Medicare and Medicaid Services' meaningful use incentives program requires interoperability.

Setting up the study 
For the purposes of this study, researchers from the Substitutable Medical Applications and Reusable Technology C-CDA Collaborative contacted 107 health IT organizations and gathered 91 Consolidated Clinical Document Architecture records from 21 different EHR systems. This research, which was published in early June, was funded by the Office of the National Coordinator for Health IT.

Once the sample records were assembled, researchers from the collaborative processed them through three steps. First, they analyzed the samples with an open-source Blue Button tool, which is a free computer program that individuals can download from The Blue Button software allows people to download, view and organize their medical histories. Next, the researchers tested their samples against a validator, which is a metric used by the CMS for EHR certification. Finally, they scored the sample records with an automated open-source tool before subjecting them to further manual review.

Results reveal a plethora of problems 
Over the course of their analysis, the researchers discovered 615 mistakes and data expression disparities, which they grouped into 11 areas that inhibited intersystem EHR operability. Example categories of problems included misuse or omission of allergic reactions, omission of the frequency with which patients take medication and lack of results from doctor interpretations.

To address these problems, the researchers suggested that EHR developers take more time to validate code, provide larger and more varied samples for public access and reduce the amount of optional data entry on EHR forms. They also suggested that federal officials should reevaluate the standards for stage 2 of meaningful use.

The study cautions that, "Although progress has been made since stage 1 of meaningful use, any expectation that C-CDA documents could provide complete and consistently structured patient data is premature." Furthermore, the researchers stated that, "Based on the scope of errors and heterogeneity observed, C-CDA documents produced from technologies in stage 2 of meaningful use will omit key clinical information and often require manual data reconciliation during the exchange."

Beta testing and bug reports 
Although this is undeniably a major issue for both users and developers of EHR, it is one that will ultimately resolve itself as the system becomes more streamlined. When the meaningful use program was first announced in 2009, many vendors scrambled to offer products to capitalize on the government program. As such, many programs never saw alpha or beta testing before being made available to consumers, effectively making the first few years of usage an extended, public-access testing phase. Furthermore, with such a disparate group of individuals developing new software from many different angles and for many different areas of medicine, it is no surprise that some of these programs have difficulty communicating with one another.

Most software goes through alpha and beta testing before releasing a final product. These are periods of bug testing where users are asked to report any operability issues to the developers, so the software can be improved. In a way, stages 1 and 2 of meaningful use are opportunities for EHR developers to test their software. As such, studies like this one are essentially bug reports. By revealing these issues and reporting them to vendors, developers are able to improve their products and implement patches and updates that resolve problems such as interoperability.