What does it mean to be "interoperable"?

A buzz word that keeps turning up in the government's push for health IT adoption is "interoperability." What this means is that an information system made by one vendor is able to exchange data with another vendor's program. The ability of hospitals to donate an EHR to physicians without violating the Stark rules is contingent on the EHR being "interoperable"—a condition that, in practice, can be satisfied if the product has been certified by the Certification Commission for Health IT (CCHIT). No interoperability features were required for certification last year, and this year, only a few features relating to lab and pharmacy connectivity are mandated. But these requirements are bound to grow in the future.

EHR vendors, meanwhile, are increasingly adding functions that enable practices to connect online with other parties: For example, Allscripts' EHR can now plug into 60 different medical devices. NextGen has been able to do that for some time with 40-50 devices. SureScripts, the pharmacy connectivity firm, recently recognized a group of EHR and standalone e-prescribing vendors for including electronic Rx transmission capability in all new installations and upgrading some of their existing customers, among other things. And more and more vendors are attaching patient portals to their software.

Despite all of this activity, however, there's little interoperability among EHRs today. The question is, do vendors prefer it that way? Would they like to preserve incompatibility among systems so that they can sell physicians and hospitals their complete family of products?

Patrick Cline, CEO of NextGen, doesn't think so. Over the last two years, he says, the industry has accepted the idea of interoperability, even though "there are vendors that are far more closed than others, both with their systems and their minds. NextGen has always tried to be an open system, and if someone wants to connect to our system, they can connect to it."

Cline cites NextGen's interfaces with many hospital systems and about a dozen practice management systems. Of course, since those interfaces had to be programmed individually, that shows openness but not interoperability. Then Cline mentions NextGen's CHS system, which is a technology that enables separately owned practices to share key data such as demographics, referrals, medication lists, allergies, diagnoses, lab results, and histories. In Ann Arbor, MI, he notes, the CHS system forms a kind of regional health information network for practices serving over 200,000 patients. That sounds encouraging, except it turns out that all of these practices are using NextGen EHRs. So there's no interoperability yet, although Cline says that CHS "is built to connect to other products. It's just a matter of time before other EHRs in Ann Arbor connect to this thing. I'd predict it will happen over the next 12 months."

On a test level, Cline notes, NextGen has demonstrated its ability to connect with other EHRs using the Continuity of Care Record (CCR), which has now been combined with HL7 in a new format called the Clinical Care Document (CCD). But he says that when his company does bridge the gap with other EHRs, it will be open to using various standards, including HL7 itself.