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Meaningful Use and Interoperability: Key EHR Challenges

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With Meaningful Use Stage 2 putting greater focus on electronic transmission of EHR data, and with less than six months before attestation is underway, vendors and providers are hard pressed to develop, test and deploy a variety of new features for effective, standards-based information exchange. In addition to the time crunch, providers also need to keep in mind that successful health information exchange for Stage 2 compliance would require much more than just the implementation of EHR features. Here are some of the key challenges that they are likely to face:

Integrating Legacy Environments

Legacy technology environments, in a sizeable number of provider settings, often have siloed data sources and use multiple incompatible standards, if at all. Many of the solutions in use are often homegrown, making

standardization and integration a slow and difficult process. The diverse healthcare standards (DIRECT, HISP,eHealthExchange) and information sharing protocols (CCD/CCDA) that are currently in use

also add to the complexity.

Making Data Security Consistent Across Applications & Health Settings

For Stage 2 requirements such as making patient-specific education resources available online and sharing lab test results, providers face multiple data security challenges including PHI and HIPAA compliance. It becomes imperative for connected systems, both internal and external, to adopt consistent standards for data encryption, identity management and secure messaging.

Connecting with HIEs for Public Health Reporting

Stage 2 requires EHRs to integrate with multiple external sources–payers, HIEs, immunization registries etc.–to share data with federal, state and local agencies. Especially in healthcare settings that have diverse, disintegrated clinical and financial systems, aggregating and standardizing information for HIE integration becomes much more complex.

Addressing Industry Challenges

There are various industry challenges facing Meaningful Use health information exchange. For example, Meaningful Use objectives define the use of DIRECT for exchanging clinical information. But it does not lay down rules or best practices on how to identify the recipient provider for the DIRECT message. Successful

DIRECT implementation would essentially be driven not only through standalone HIT vendor solutions but also through collaborative partnerships within the industry.

Demonstrating Meaningful Use, Not Just Implementation

Last, but not the least, having deployed the required features, providers still need to demonstrate meaningful use. This depends greatly on patient awareness and the adoption of patient educational resources or patient portals. Organizations would need to focus on driving patient adoption through reminders and alerts, and leverage mobile devices and social media for better patient engagement. On the other hand, EHR vendors need to closely track consumer usage patterns in order to develop easy to use interfaces to their applications.

The above challenges, while not being new to the industry, are much more relevant today in the context of emerging regulatory requirements like Meaningful Use. Addressing many of these challenges will be a fairly long-term proposition, and won’t be met just through adoption of specific EHR technology alone. Successful implementation will involve a collaborative effort between various EHR technology vendors, HIE initiatives and healthcare organizations themselves.


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