Interfacing Registries with EHRs

1. Interfacing Registries with EHRs Nancy Dreyer MPH, PHD Outcome DEcIDE Center

2. Authors and Reviewers AuthorsReviewers Dan Levy (lead) Jonathan Einbinder Outcome Partners HealthCare Richard Gliklich John Halamka Outcome Harvard University Landen Bain CDISC

3. Introduction • Importance of interfacing registries with EHRs will increase over the next few years. • Roles of EHRs and registries are distinct and important. • This white paper explores issues of interoperability and a “building block approach” towards a functional, open-standards-based solution. • EHR vendors can implement it without major effort or impact on their current systems. • Same approach is applicable to clinical research studies, safety reporting, biosurveillance, public health, and quality reporting.

4. Background • Recent reports indicate that only a small minority of U.S. physicians have implemented partial or complete EHR systems in their practices. • American Recovery and Reinvestment Act of 2009 allocates $19 billion in incentives to clinicians to adopt EHR systems that meet criteria to be established by 2010. • Under ARRA, HHS will take on more active role in setting certification standards • Creation of interoperable HIT infrastructure is integral to ARRA goals including generating information on CE and measuring quality

5. EHRs and Patient Registries • EHR: an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff, across more than one health care organization. • Individual focused • Patient registry: an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical or policy purposes. • Population focused

6. Current Challenges • Healthcare facilities that participate in registries often use more than one data capture system, many use more than 4. • If not interoperable, increases burden of data entry, training, --presents a high barrier to participation in registries and other studies • No current EHRs are fully interoperable in the core functions defined by IOM. • Paradox: The widespread implementation of EHRs that are not interoperable will create barriers to the growth of evidence development • By providing mechanisms that allow for linkage between EHRs and registries, providers could link to any number of registries from their EHRs.

7. Interoperability Challenges • Syntactic interoperability (communication): the ability of heterogeneous health information systems to exchange data. • Wiring, application protocol, standard messaging protocol • Most easily solved • Semantic interoperability (content): implies that the systems understand the data that has been exchanged at the level of defined domain concepts. • Depends on standard vocabulary and shared data elements • More difficult to solve; efforts include CDASH, ASTM Continuity of Care Record (CCR), HL7 Continuity of Care Document • Other issues: managing patient identifiers and authenticating users across multiple applications.

8. Partial and Potential Solutions • Addressing all of the issues in interoperability is overwhelming. • Many in the standards community have turned towards a more incremental approach towards a level of ‘functional interoperability’. • The ability of any EHR to exchange valid and useful information with • any registry • on behalf of any willing provider at any time • in a manner that improves the efficiency of registry participation for the provider and the patient and • does not require significant customization by the EHR or the registry system.

9. Partial and Potential Solutions: Building-Block Approach • Alternative to complete semantic interoperability Increasing specificity

10. Example: Building Block Approach Standards-Based Health IT integration

11. Conclusions EHR–registry interoperability will be increasingly important as adoption of EHRs and patient registries increase significantly. Interoperability should be based on open standards that enable any willing provider to interface with any applicable registry without requiring customization by the EHR vendor. Functional interoperability’ provides a near-term goal with significant gains in improving workflow and reducing duplication of effort for registry participants. The development, testing and adoption of open standard building blocks that improve functional interoperability and move us incrementally towards a fully interoperable solution is a bridging strategy that provides benefits to providers, patients, EHR vendors and registry developers today.