Prerequisites for Achieving Interoperable EMR and EHR

Today I came across an organization called the Electronic Health Record Association (EHRA). It looks like it’s kind of a consortium of EHR vendors that are also members of HIMSS. I’ve just begun reading some of the work and goals they have. A very interesting organization. I have much to say about what I’ve read, but one of their main initiatives seems to be the EHRVA Interoperability Roadmap. I took a quick look at version 2 of the document to try and gain an idea of how they were trying to accomplish the lofty and difficult goal of interoperable EHR/EMR software.

Briefly looking at the document one section in particular caught my eye that was called “Prerequisites for Achieving Interoperability.” I was excited to read what they thought was important for interoperable EMR software and the following is what I found:

The path to interoperability is fraught with challenges. Some of them are technical – determining what standards should be used to achieve interoperability and implementing those standards within HIT systems. Some are cultural – encouraging both vendors and providers to share information. And some are financial – identifying sources of funding needed to acquire the technology and to establish and sustain health information exchanges.

Nonetheless, we believe that interoperability is achievable, under certain conditions outlined in this Roadmap.

I was really disappointed in their list of prerequisites. Not one mention of the legal issues related to interoperability? That seems like one of the largest problems with interoperable medical records. It kind of falls under cultural, but it still should have at least been mentioned under cultural if that was their intention. An interoperable EMR is no use if legally you can’t exchange those records easily.

At least they did talk about the need to find a motivation mechanism for vendors and providers to share information. The honest truth is that interoperable EMR software doesn’t sell more software. Not to mention, there’s very little financial benefit for a doctor to spend time sharing information either.

The key is that interoperability is important and finding ways to meet/overcome these prerequisites is important and worthy of significant attention.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Electronic medical records is a good new market for GE and others; electronic medical records can increase efficiency and only about 10% – 15% of hospitals — and about the same percent of doctors — have adopted EMR systems.

    What’s tougher is the big price tag: Will electronic records really decrease healthcare costs? We know there will be a spike in costs at the outset, and that the systems are likely to cost more than anticipated. The ROI is still unclear.

    Even trickier is the underlying logic of these systems, especially around the need to assure and deliver quality, consistent care. Do they incorporate the smartest diagnostic and quality care guidelines? Do they make evidence-based clinical information available at the bedside, along with the patient’s individual and historical information? Not all EMRs are created equal.


  • A clear path is quietly emerging that addresses all three of these issues – the use of software agents in a distributed setting has proven to be successful in 50+ health systems and over 300 hospitals. Here’s why:

    1) Agents bridge standards rather than make participants comply to a single standard. With thousands of HL7 variants already in place across the US in the payer, acute, ambulatory, etc markets, even if there was a tight standard it would take years (decades?) before everyone was compliant. Agents allow exchange between participants using paper, HL7, documents (pdf), CCR, CCD, CDA, XYZ…

    2) Agents are higly distributed and don’t aggregate data. Thus, no participant has to worry about paying for part of a massive IT infrastructure – and figure out how to budget to make it scale as others come onboard. More importantly, no one has to worry about aggregating all their clinical / admin / financial data with a competitor’s data in a big data warehouse.

    If aggregation is required / desired, agents can feed those systems as a by-product of the exchange process. This can be done at little or no incremental cost. UPMC uses their physician exchange architecture to send ADT face sheet data to the EMS service’s billing system (Lisa Khorey presented on this topic at the PA Healthcare Trade Faire last month)

    3) Funding is not an issue with an agent architecture that is deployed to solve real-world business problems. The 50+ institutions using agents (Intermountain, Spectrum, Trinity, Adventist, Catholic Health Systems, Catholic Health East, UPMC, etc) have all cost-justified their deployment on three factors:

    – Agents are a LOT less expensive than an aggregated, federated or point-to-point infrastructure, so the ROI is easier to justify.

    – Agents improve physician relationships by lowering admin costs for the hospital (eliminate fax, mail, courier) and the practices (eliminate unwanted document faxes, eliminate scanning and indexing into EMRs). In doing so, physicians have a greater tendency to refer to the hospital’s inpatient and outpatient services.

    – Agents can work with ANY practice environment – whether paper, document-image or EMR. By deploying agents in every practice (via a simple internet download), the health system can be prepared for a complete EMR exchange strategy in the future – at a very low cost. Changing an agent from paper exchange to EMR exchange is a simple task.

    Agents are rapidly demonstrating how they can enable community exchange and address the issues cited by lowering cost & complexity, providing high-value, rapid ROI and building a strategic platform for the future while solving near-term tactical problems.

    Google “Agent Grid” healthcare and look for articles from UPMC, Intermountain (Most Wired Online), HISTalk, etc.

  • Not to be sarcastic but:
    # Bill Sims commented on November 20th, 2008:
    That agents allow exchange of information using paper (and other methods) and then later says there are no unwanted faxes, scanning or couriers. So I am VERY interested in the details of this solution. Please email me.

    Actually the real solution to interoperability is an abstract, openly available, comprehensive information model. See

  • Tim,
    openEHR looks like an interesting initiative. What is your role in its implementation? I’m going to send you an email to see if you’d be willing to do a guest post on the project.

Click here to post a comment