The importance of achieving interoperability with your EHR software.
The interoperability of software and technological devices is a hot-button issue in medical practices today, because of the health information exchange (HIE) requirements of Stage 2 of the meaningful-use (MU) electronic health record (EHR) program. So what should you know as a chiropractor?
You are—or should be—aware of the EHR incentive program. Part of the American Recovery and Reinvestment Act of 2009, the program was designed to encourage healthcare providers to replace their paper charts and files with EHR systems. Early adopters could have received up to $44,000 for implementing EHR and meeting certain usage benchmarks. Several of those requirements concern health information exchange (HIE).1
HIE as a verb describes the exchange of health information between two or more parties, usually between the patient and the provider, but also among healthcare providers. HIE as a noun refers to an organization that acts as a repository for health information—typically referred to as a health information organization, or HIO.
Interoperability, as defined by the Healthcare Information and Management Systems Society (HIMSS), is “the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.”2
There are three levels of interoperability:
Foundational: an interoperability model in which two health information systems can exchange data without either system interpreting the data in an advanced way. It solely includes data transfer from one system to another and is the only level of interoperability supported by most health information technology today.
Structural: two or more health information systems that can exchange data and interpret its meaning by understanding the data’s positioning and what each column, row, or field signifies, and how the meaning of the data changes when its position does. HL7-XML, covered below, is an example of structural interoperability.
Semantic: the most complex and highest level of interoperability. Semantic operability allows health information systems to transfer data and determine its meaning based on terminology, not positioning, which enables exchange and machine interpretation of patient encounters or SOAP notes. This level of interoperability is difficult due to the fragmented nature of healthcare terminology; practitioners can refer to the same procedure in vastly different ways across or even within healthcare organizations.
Pointing at you
The idea behind HIE and HIOs is that electronic health records, diagnostic results, and other health information should be easily sent from one provider to another, such as when a primary care physician refers someone to a specialist.
But, as the well-documented payer discrimination against doctors of chiropractic shows, primary care and other physicians are less likely to refer patients to you.3 If you’re one of the many chiropractors who operate as a single-provider practice and don’t view cross-referrals as a priority, why should you be concerned with interoperability and HIE?
Beyond the MU Stage 2 stipulations requiring providers to give patients timely electronic access to their health information, as the industry moves away from a fee-for-service model and toward a pay-for-performance and managed care compensatory structure, HIE and interoperability will become increasingly important for everyone.4
If you want to be included in the new accountable care organizations, you will need to use software that communicates with other providers in addition to payers and HIOs. To that end, if you’re considering a software purchase, ensure whatever software you select meets certain criteria.
The single most important feature in achieving software interoperability— besides Internet access—is Health Level Seven Extensible Markup Language, or HL7-XML.5 Usually referred to as just ‘HL7,’ HL7-XML is the most widely-used format for storing and exchanging electronic medical records. HL7 allows for structural interoperability, but along with ICD-10, it lays the foundation for achieving true semantic interoperability.
Another important feature to consider when discussing HIE and interoperability is the patient portal. Patient portals, of course, are intended for use by patients, not other providers. That said, if all other things are equal, software with a patient portal enables HIE—at least HIE that uses patients as the means of exchange—and is more likely to support true interoperability than software without it.
In short, if you’re considering an EHR or practice management software purchase, make sure that your selection meets current MU requirements for interoperability and HIE, even if you aren’t participating in the MU incentive program. Purchasing software that supports interoperability and HIE through HL7 and patient portals will help ensure your continued relevance in the brave new world that is the future of U.S. healthcare.
CHARLES SETTLES is a product analyst at TechnologyAdvice. He covers topics related to Health IT, business intelligence, and other emerging trends. He can be contacted through technologyadvice.com.
1 TechnologyAdvice. “TechnologyAdvice Guide to Chiropractic Software.” http://technology advice.com/medical/chiropractic- software/smart-advisor/. Accessed April 2015.
2 Healthcare Information and Management Systems Society (HIMSS). “What is Interoperability?” http://www.himss.org/library/ interoperability-standards/what-is. Accessed April 2015.
3 Hamm AW. “Re: CMS-9942-NC, Request for Information Regarding Provider Non- Discrimination.” American Chiropractic Association. Published June 9, 2014. Accessed April 2015.
4 Centers for Medicare and Medicaid Services. “EHR Incentive Programs: Stage 2.” http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/St age_2.html. Accessed April 2015.
5 Health Level Seven International. “Introduction to HL7 Standards.” http://www.hl7.org/ implement/standards/. Accessed April 2015.