EHR Interoperability Standards

EHR Interoperability

EHR Interoperability is a challenging concept.  Despite elctronic data interchange standards, EHR interoperability is difficult to achieve.  Hospital and physician group consolidation is increasing the heterogeneity of EMR systems under one roof.   New hospitals want to integrate the clinical data with other hospital systems, and create patient monitoring solutions and dashboards. Health plans as well as hospitals can benefit from a well thought out integration strategy. Electronic Health Records (EHR) or Electronic Medical Records (EMR) integration approaches depend on the strategy and priority in exchanging patient information between various healthcare applications, and the standards available: Standards and approaches for EMR and EMR Integration

  • HL7 – A set of standards for structuring and exchanging clinical data. ASTM is an alternative standards group and both have their own vested interests and objectives.
  • HL7 CDA – XML-based exchange model for clinical documents (for example, progress notes and discharge summaries)
  • CCR – Continuity of Care Record – is an XML-based standard focused on organizing a transportable set of information about a patient’s health care that is accessible for both patients and clinicians.  The CCR was created by ASTM International, Massachusetts Medical Society (MMS), HIMSS , the American Academy of Family Physicians (AAFP),  American Academy of Pediatrics (AAP), and other health informatics vendors. It was designed to contain the most relevant and timely core health information about a patient.  It has been adopted by healthcare application vendors, including Google for its Patient Health Record.
  • CCD – this combined Continuity of Care Document – A blend of the CDA and CCR standards as a result of harmonization of standards in 2007.  Currently, CCD is being phased into EMR certification standards by CCHIT. It is an HL7 standard whereby a patient’s current clinical context is expressed in the framework of the Clinical Document Architecture.
  • ELINCS – EHR-Lab Interoperability and Connectivity Specification  – A standard for lab test results
  • EMR Vendors – Depending on the vendor, both proprietary and standards based specifications integrating with data fields in the vendor specific application

Interoperability Strategies and Best Practices Building communities of more efficient physicians that are integrated electronically can benefit both health plans and hospitals.  Today, some  health plans still request patient medical records manually, paying up to $1.00 per faxed page to receive the records.  The records must then be re-keyed and loaded into the payor’s systems.  For hospitals, the heterogeneous nature of EMR and EHR systems mean multiple integrations to build, support, and maintain. There are both technology and processes approaches that can be useful to implement a strategy effectively. We have found that using a business road map approach to facilitate business, IT, and medical director alignment is key.  Physician out reach during and post integration is also important.  A services oriented architecture that enables easy integration with these standards, scalability, rules and business process modeling will provide an important foundation for interoperability. Keep an eye on ONC and CCHIT to view the standards that are gaining certification.

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Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See and for more about the company.

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