EHR template customization contributes to MU2 interoperability issues, vendors say

Electronic health record (EHR) systems certified for Meaningful Use stage 2 (MU2) are often unable to exchange patient data between providers, despite this being one of the requirements for attestation, EHR vendors and physician advocates told a government committee.

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During a meeting of the Health IT Standards Committee’s implementation workgroup, technology vendors said that the templates, called the consolidated clinical document architecture (CCDA), are often coded improperly in EHR systems, preventing exchange of health data, reports Bloomberg BNA. While some data can be transmitted, it often requires providers manually entering the data into their system.

Emily Richmond, MPH, a senior product advisor for EHR vendor Practice Fusion, told the committee that while Practice Fusion is one of a small number of companies certified for MU2, fewer than 8% of the vendor’s customers have sent clinical data to another provider, and only 1% have both sent and received patient data via CCDA.

One of the problems with the CCDAs, Richmond said, may be how variable they can be, since many vendors customize templates for physician customers.

“Greater interoperability would require stricter and more clearly defined standards with less flexibility in implementation,” Richmond said in her presentation.

The work group is considering more stringent guidelines of vendors during the certification process. The tradeoff is that this would limit the customization and template choices that EHR vendors can provide their customers.

Vendor representatives suggested that the Office of the National Coordination for Health Information Technology (ONC) begin testing EHR systems as part of the certification process to catch interoperability issues. Matt Reid, a representative of the American Medical Association, testified that ONC’s certification process tests the creation and transport of CCDA, not intake of the data by another EHR system.

Reid said the Centers for Medicare and Medicaid Services (CMS) and ONC should clarify their implementation guidelines and limit future meaningful use guidelines to ones that have been “well tested, understood, and are associated to rich implementation guidance.

“This may require learning from the current and past stages and better coordination with standards development organizations before attempting to force the hastily progression to future stages,” Reid said.

MU2 attestation has been slow for both providers and hospitals. As of July 1, of the 2,823 eligible providers (EPs), 972 had attested to MU2. That number is up from the last MU2 status report CMS released in May, when only 50 EPs had attested. Of the 128 eligible hospitals, only 10 have attested to MU2.

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