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Where Interoperability, Integration Fit into EHR Selection

A new ONC guide pinpoints EHR contract language that could limit EHR interoperability and integration.

By Kyle Murphy, PhD

- As part of its effort to improve health information sharing, the Office of the National Coordinator for Health Information Technology has issued new guidance for healthcare organizations to consider during EHR selection and contracting.

Impact of EHR selection on EHR interoperability, integration

As part of a section fostering interoperability and integration, the federal agency has warned EHR adopters about the inability or unwillingness of some EHR vendors to support health data exchange and integration.

"You should be aware that not all EHR vendors offer the same capabilities for sharing, receiving, and integrating data with other sources," states the guide, EHR Contracts Untangled.

"As a result, a vendor’s willingness to support your need to exchange and integrate data may be a key factor in deciding on your preferred EHR," it continues. "Your EHR contract should bind the EHR vendor to the promises that it made to you about interoperability and integration, and the costs and timelines associated with achieving your desired level of interoperability."

The ONC guide pays special attention to contract language pertaining to EHR integration with a practice's existing systems.

"It is helpful to determine early in the selection process whether a particular EHR will efficiently interface to all other systems and services you currently use, or propose to use in the future, and to obtain the EHR vendor’s commitment to provide the initial interfaces and keep them up to date," the federal agency advises.

According to the guide, the use of both new and pre-existing interfaces could make EHR adopters subject to additional fees. ONC recommends that providers demand fee quotes from their EHR vendors to determine what is and is not covered.

What's more, language related to the definition of EHR software should include details about interfaces.

"Standard form EHR contracts seldom address interfaces in depth so you may need to negotiate to obtain the EHR vendor’s promise to keep the interfaces up to date as changes occur in the EHR technology itself and in the third party software or services to which your EHR is interfaced," ONC points out.

If faced with resistance, the federal agency advises that EHR adopters to remind the EHR vendor that it could prove to be a deal-breaker.

For their part, EHR users must do their own due diligence in ensuring that interfaces are working at agreed upon and continue to receive updates and upgrades to maintain compliance with HIPAA and other health data privacy and security regulations.

The ONC guide also focuses on the ability of EHR technology to integrate with third-party products and provide data access, a lack of which could have downstream implications for healthcare organizations working to incorporate innovations in health IT into their EHR platform.

"Unless you negotiate more favorable terms, a standard form EHR contract may not allow you to give third party developers access to the EHR technology or to the data necessary to provide services that may fall outside of the scope of core EHR functionality," the document states.

According to ONC, the onus is on EHR adopters to ensure that they have the flexibility to make use of third-party applications and services that emerge over time.

"To help assure that you can leverage new innovations and the most appropriate solutions for your needs, you should consider negotiating appropriate rights and obligations in your EHR contract, including the right to grant third-party developers and service providers sufficient access to your EHR and data to provide services for you," the federal agency recommends.

ONC urges EHR adopters to keep an eye out for EHR contract language limiting EHR system customization, integration of third-party technology, and access to data or data formats.

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