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New health IT architecture requires interactive EHRs, scientists advise


By Joseph Conn
Posted: April 18, 2014 - 2:45 pm ET
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To help create a new health-information architecture, the current crop of electronic health-record systems needs to be connected using interfaces that will allow them to communicate with each other, according to recommendations from a group of U.S. scientists reporting on the nation's health-information interoperability needs.

The scientists' group, known as JASON, produced a 65-page report, under contract with the Agency for Healthcare Research and Quality at HHS, advocating health IT infrastructure that provides “a migration pathway from legacy EHR systems,” the report stated. It calls for federal mandates to use what are known as application programming interfaces, or APIs, to connect legacy systems to each other.

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“This pathway could be provided by published APIs mandated through the CMS Stage 3 Meaningful Use program,” the report's authors said.

The Stage 3 requirements of the federal EHR incentive payment program created by the American Recovery and Reinvestment Act are under development and most likely won't go into effect until at least 2017.

The group also recommended all data be encrypted, both at rest and in transit. It further suggested the use of metadata tagging affixed to discrete data elements within an EHR to identify the data's content and provenance, a recommendation that echoes a report from an earlier group of scientists, the 2010 report by the President's Council of Advisors on Science and Technology.

The PCAST report received only a tepid response from healthcare IT practitioners and its recommendation have not been widely embraced within the industry.

With the PCAST, “I didn't know how we'd practically go anywhere with it,” said Keith Figlioli, senior vice president of healthcare informatics at group purchaser Premier. Figlioli serves as a member of the Health Information Technology Standards Committee, which makes recommendations to the Office of the National Coordinator for Health Information Technology at HHS, including recommendations on the needed technical capabilities of EHRs for meaningful use. He is a former senior vice president with EHR developer Eclipsys, which was acquired by Allscripts in 2010

Discussing the latest report, Figlioli said, “This is a bit more practical.”

The JASON group envisions interoperability at the query and response level, which is a step up from the most common interoperability level currently achieved between healthcare organizations.

“API is just a set of functions and procedures for one computer program to talk to another,” he explained.

Figlioli said a move to the architecture envisioned by the JASON authors is inevitable.

“The obvious question is, how long is it going to take? I think is could be as long as a decade, or it could be as short as five years,” he said.

The JASON group formed late in the administration of President Dwight Eisenhower to advise the government, primarily the Department of Defense and the intelligence services, on scientific issues. Now under the administrative auspices of the MITRE Corp. in McLean, Va., it still performs consulting work for the military, but has since branched out into other fields, including healthcare technology.

Follow Joseph Conn on Twitter: @MHJConn


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