Commentary: Micro Vs. Macro Approach To iEHR Interoperability

There are many approaches to achieving electronic health record (EHR) interoperability. One way is to collaborate to build an entirely new EHR from the top down. In fact, this “macro level,” top down approach was attempted — but has since been scrapped — by the U.S. Department of Veterans Affairs (VA) and the Department of Defense (DoD). The two departments recently suspended their joint project aimed at building a comprehensive, new integrated electronic health record (iEHR) to pursue instead the interoperability among their existing legacy EHR systems.

The suspension of the project highlights the considerable challenges for healthcare organizations that elect to engage in a macro-level approach to achieving EHR interoperability. At the same time, it spotlights the strengths of a micro level approach that instead aims to establish interoperability from the bottom up, one or more specialty unit at a time.

The original goal of the two departments’ ambitious project was to pull together disparate DoD and VA data onto a single architecture, helping to standardize critical patient and financial information between the two departments for full interoperability and enhanced functionality. [...]