Stakeholders To ONC: No One Architecture Perfect For EHRs, Data Sharing

Interoperability is a major part of Stage 3 of Meaningful Use, but the timeframes may be too short to transition from current Consolidated Clinical Document Architecture (C-CDA) used in Stage 2 to the application program interfaces (APIs) and proposed HL7 Fast Healthcare Interoperability Resources (FHIR) Standard for Stage 3, according to vendors and stakeholders speaking at a recent joint Health IT Policy and Standards Committee listening session.

At the session, which explored whether APIs should be considered for electronic health record interoperability, witnesses expressed concern with both types of architecture, noting that C-CDA was not perfect, but--as Anil Sethi, CEO of GLIIMPSE, testified--that FHIR "was not ready for prime time." The Health IT Standards Committee implementation workgroup acknowledged in its meeting July 28 that the C-CDA for document exchange was faulty. EHRs must produce C-CDA documents to meet Stage 2 of the Meaningful Use program.

Carl Dvorak, president of Epic Systems, suggested that the industry does not necessarily need to rework technical architecture. He also said that since EHRs already share data constantly, such as in e-prescribing, a recent JASON report that expressed concern about the lack of interoperability among EHRs was a "false premise." Dvorak recommended that what's really needed are standards and "basic governance."...