Today's monolithic EMRs delay hope for the 'learning health system'

Key Points

WIDESPREAD ADOPTION of electronic health records (EHRs) is central to the Federal Health IT Strategic Plan. However, in the rush to adopt EHRs and gain federal funding perks, providers could find themselves less connected than they anticipated.

Interoperability is the key to progress. The President's Council of Advisors on Science and Technology (PCAST) report, issued in December 2010, emphasizes the need for data liquidity. This liquidity, PCAST found, is impossible with continued use of monolithic systems that cannot interoperate and is markedly absent from today's health information technology.

The Federal Strategic Plan indicates that the information exchange function central to realizing the benefits of EHRs does not exist today because there is no interoperable infrastructure to support it. However, in the plan, requirements for interoperability and health information exchange are kicked down the road for the later stages of meaningful use.

"This is going to be ONC's summer of fun," says Harry Greenspun, MD, senior advisor, healthcare transformation and technology, Deloitte Center for Health Solutions. "The work groups this summer have to decide the criteria for Stage 2 meaningful use, and how the staging will be timed. Everyone is anxious to see how that is going to turn out."

PCAST focuses on a specific solution to achieve semantic interoperability-the ability not just to exchange information but to interpret exchanged data automatically, meaningfully, and accurately-creating what ONC refers to as a "learning health system."

A learning health system, according to the IOM, is a system that is designed "to generate and apply the best evidence for the collaborative healthcare choices of patients and providers; to drive the process of new discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in healthcare."

Such a system is even more far reaching than meaningful use itself.

The right way forward, according to PCAST, would be to create an XML architecture for EHRs. Seamless interoperability, as well as privacy and security, would be built into a standardized system for this purpose. Many of the existing EHR solutions and the legacy systems in use are not written in or based on XML.

ONC's first goal for EHRs is rapid adoption, and so it leaves the door open as to how to achieve that. Some providers are moving forward as quickly as possible toward adoption, hoping to qualify for federal funding under HITECH.