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AMIA Offers Strategy for EHR Interoperability, Data Exchange

By Kyle Murphy, PhD

- Of the recommendations made by a group convened by the American Medical Informatics Association (AMIA) relating to the current status and future direction of EHR technology, three have implications for EHR interoperability and data exchange.

The AMIA EHR 2020 Task Force has recommendations about EHR interoperability, data exchange

The association commissioned the EHR 2020 Task Force to provide recommendations for resolving EHR-related issues ranging from physician EHR documentation and meaningful use regulation to fostering EHR innovation and the role of EHRs in supporting patient-centered care.

In total, the AMIA EHR 2020 Task Force has published ten recommendations across five areas in its report in the Journal of the American Medical Informatics Association.

As part of the second area — refocus regulation — the group calls for EHR certification requirements that focus on  technical requirements capable of improving EHR interoperability and health data exchange as well as supporting quality reporting and safe, secure care. Additionally, the AMIA EHR 2020 recognizes the role of regulation in "reducing barriers to interoperability and efficient data flow."

Health IT standards and application programming interfaces (APIs) also feature in the group's recommendations as part of fostering innovation.

According to the AMIA EHR 2020 Task Force, the shift of health systems from in-house to commercial EHR products has the consequence of "potentially restricting" the flow of EHR data and researcher access this information. As a result, pressure is on EHR vendors and innovators.

"In short, we believe that EHR vendors should become more open to both extracting data from the EHR as well as creating novel ways to interact with externally defined applications," writes Payne et al. "To get there, we need APIs, data element standards and other ways to efficiently extract data and interact with commercial EHRs."

The AMIA EHR 2020 Task Force points to emerging standards such as Fast Healthcare Interoperability Resources (FHIR) as providing the means for creating an open, standards-based EHR ecosystem.

What's more, this ecosystem must allow input from not only other providers but also patients themselves.

"We foresee the day when prescribing an 'app' as part of a care plan and incorporating app-generated data into a treatment record and subsequent care plans will be a routine occurrence. Patient access to these data will empower consumers to support national initiatives such as precision medicine," the AMIA EHR 2020 Task Force adds.

EHR integration and interfaces round out the group's recommendations that have a bearing on EHR interoperability and data exchange.

In order for EHR technology to support patient-centered care, Payne et al. recommend the integration of EHR data with other information about individuals and populations.

"The principles of person-centered care can be much enhanced with the integration of new systems, such as smart phones, biometric sensor information, genomics, big data, etc.," the group maintains.  "Although there are technologies and services poised to encourage consumers to interact with their own health data (Fitbit, Apple HealthKit, 23andMe, etc.), they lack integration, usability and ubiquity in the health care domain."

In other words, interoperability needs to span the care continuum. The recommendations of the AMIA EHR 2020 Task Force extend well beyond EHR interoperability and data exchange but they very much echo industry feedback about what needs to occur in order to realize a learning health system in the United States.