Having the Same EHR Vendor Does Not Ensure Health IT Interoperability

EHR interoperability with the same health IT vendor is still far from perfect due to limited data standards adoption, according to a study published in JAMIA.

That said, having EHR implementations from the same health IT vendor within a given health system still helps data exchange.

Researchers calculated inter- and intra-EHR vendor interoperability scores based on data from 68 oncology sites that implemented one of five EHR vendor products.

Intra-vendor interoperability is defined as the ability to share data between instances of the same vendor’s product. Inter-vendor interoperability refers to the ability to share information between instances of different vendor products.

The study authors calculated interoperability scores based on 12 data elements (six medications and six laboratory tests) common in oncological care for which well-accepted data standards exist.

They found that inter-vendor interoperability was lower than intra-vendor interoperability (0.22 vs 0.68, respectively, if weighted by the number of implementing sites). In other words, inter-vendor interoperability is challenging, and sites that implement the same EHR vendor product are more likely to be able to exchange data.

However, the researchers found that interoperability is far from perfect, even between sites that leverage the same vendor.

“Vendor choice does not ensure reliable interoperability,” the study authors wrote. “Reliable interoperability requires institutions to map their data to the same standards and ensure that mapping practices are consistent across institutions.”

In particular, many key oncology tests remain uncoded in the EHR due to the mechanics of collecting the information, they noted.

“One prime example of this is estrogen and progesterone receptor and human epidermal growth factor receptor 2 (HER2) status in breast cancer,” the researchers wrote. “Because this information is manually transcribed from pathology reports by clinicians, it often comes with no coding, despite the fact that the actual value and methods (particularly for HER2) can be crucial for making clinical decisions.”

The researchers noted that they hope the health IT community will expand upon their work to develop a relevant measure (or multiple measures) of interoperability.  

“Multiple measures may be needed because some medical specialties, such as radiation oncology, may require assessment of data elements that are not relevant for general EHRs,” the study authors wrote. “Interoperability measures should also account for increased use of coded values, and whether the coding specifics improve or hinder interoperability.”

An alternative to specialty-specific interoperability measures could be the use of interoperability profiles based on data types such as medications, laboratory results, and risk assessments.

This approach would allow stakeholders to measure interoperability of systems that support limited aspects of healthcare delivery, like ePrescribing or imaging. For example, the researchers noted that two systems may be more interoperable with respect to medications than with respect to laboratory test results.

All approaches to measure EHR vendor interoperability will require careful selection of data elements and values, the research team emphasized. Stakeholders must also make determinations of reasonable weights for each of the elements. For instance, interoperability of common medications may be weighted more than rare medications.

The study authors pointed out that interoperability is based on a combination of the vendor’s default product features and implementation choices made by healthcare organizations. A potential consequence of implementing objective interoperability measures could be that vendors or institutions will focus their data sharing efforts on data elements used for interoperability assessment.

“Just as in the economics domain where the Consumer Price Index can be manipulated to artificially reduce apparent inflation, it will be important to ensure that certification does not replace poor interoperability with poor interoperability except for a few chosen data elements,” the study authors explained.