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Federal report proposes software architecture promoting interoperability

November 16, 2014

Doctors Look at Laptop Together

During the past few years, the federal government has been pushing for U.S. practitioners and hospitals to adopt electronic health record systems. The rationale is that the technology will play a pivotal role in reducing health care costs. Savings will come from process improvements such as the reduction in redundant medical tests and procedures, better diagnosis and prevention of medical conditions through the sharing of information between providers, and fewer medical errors attributable to illegible physicians' instructions.

However, the full potential of EHRs cannot be realized unless two conditions are met: EHRs and other health information technologies are adopted more universally and the systems used by various providers are able to easily communicate with each other. Currently, interoperability improvements are needed and a report compiled by JASON: The MITRE Corporation on behalf of the federal Agency for Healthcare Research and Quality proposed a plan to bring interoperability to fruition.

Report's 'architecture' addresses necessary software components
According to the JASON report, evidence supporting the benefits of EHRs has slowly but surely been building. For example, one recent study of 180,000 outpatients and 800 clinicians suggested that EHRs helped reduce the overall cost of outpatient care by 3.1 percent in communities that used the technology compared to communities without EHRs. Considering that a significant number of patients may move around among various health providers, interoperability and health information exchange may greatly boost those savings. However, the current lack of interoperability among different EHR systems is a major challenge.

To help overcome this obstacle, the JASON report proposed an EHR architecture to guide the creation and interoperability of patient data. Recommended components included:

  • Agnosticism to type, scale, platform and storage location of data;
  • Use of public open standards;
  • Encryption of data at rest and transit;
  • Separation of key management and data management;
  • Inclusion of metadata and chain of customer information with data';
  • Liberalism in information that is accepted and conservativeness with information that is sent out; and
  • Migration pathways from legacy EHRs.

In addition to helping reduce the cost of health care, such an architecture would benefit research by providing interoperable repositories of clinical data which can be studied.

"The federated database will provide large effective sample sizes, both to support statistical significance and to identify statistical outliers," the JASON report read in part. "In the near term, the data will consist mostly of traditional EHRs, including information about medical history, physical examination, physicians' notes and orders, laboratory reports, and medical treatments. These data are already being supplemented by genomic data, expression data, data from embedded and wireless sensors, and population data gleaned from open sources, all of which will become more pervasive in the years ahead."

To promote the implementation of this architecture, the JASON report had several recommendations.  Meaningful Use criteria for Stage 3 should promote policies that drive interoperability between EHRs. Additionally, the federal government should define the software requirements for organizations, patient privacy, clinical care access, biomedical research and functional interfaces so that stakeholders have a blueprint for interoperability. In addition to promoting better healthcare, these policies and definitions will create new entrepreneurship opportunities for vendors who create EHR products that accommodate interoperability.

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