Off the record

Even among health care providers with electronic medical records, interoperability remains an issue.

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So far, the HITSP has ironed out interoperability specifications in several application areas, such as how to send lab and clinical data from place to place. Halamka describes the specs as "an unambiguous cookbook for creating an interoperable message for any application."

It is also working on a specification for medication management that blesses a standard called Rx Norm, as well as standards for personal health records and other matters.

By evaluating existing standards against specific use cases, the HITSP has dramatically reduced the number of standards the industry must follow. In 2006, it reduced 700 standards to 30. Last year, it considered 200 standards and settled on 20. Eighty percent of those standards were overlapping, Halamka says. Now, he says, "we're really getting down to a finite, constrained set."

If the HITSP provides the cookbook, the CCHIT is testing the vendors' recipes. The government-funded certification body started testing the interoperability of ambulatory health records two years ago and has since tested lab and prescription systems to make sure they can send and receive data in industry-standard formats. Anyone buying a certified electronic health record system today can be assured of interoperability in these areas, says Leavitt. "That's a big step."

Both the HITSP and the CCHIT have balanced membership among vendors, providers and payers. "No one sector is going to dominate," Leavitt says.

"There will be a lot of convergence over the next two years," Halamka predicts, although it will take time for compliant technologies to work their way into existing health care systems.

But some pieces are still missing. "We have standardized messages, but how you get it from Doctor A to Doctor B is still in flux. In other words, we haven't standardized the plugs and sockets," and that will be necessary for exchanges to take place between institutions, says Leavitt.

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Copyright © 2008 IDG Communications, Inc.

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