Widespread Support for Adopting Tools Needed to Tap Potential of Electronic Health Records

Dozens of organizations representing electronic health record (EHR) developers, health information technology professionals, doctors, and other relevant interests recently backed draft government regulations that would give patients and providers easier access to medical records. Given the widespread support, the Office of the National Coordinator for Health Information Technology (ONC) should finalize its proposed regulations as soon as possible so that patients and clinicians can reap the benefits of new tools to foster greater data exchange.

Although EHRs are now used in nearly every U.S. hospital and physician’s office, many patients seeing a new doctor or specialist may still need to bring paper medical records. Too often, current systems cannot easily share information with each other—a concept known as interoperability—or translate the data received into the proper format.

Application programming interfaces (APIs) already allow services, such as travel and personal finance websites and smartphone applications, to organize and display information from multiple sources. If broadly used in health care, APIs based on common standards could also sync data across EHR systems and feed that information into apps that let patients share their medical records with caregivers or alert clinicians to best practices for treatment.

In response to congressional directives in the 21st Century Cures Act, passed in 2016, ONC issued draft regulations earlier this year that would use APIs to grant access to EHR data, and make more patient information available in a secure, standardized manner. The agency, part of the Department of Health and Human Services, achieved this in several ways, most critically by encouraging the use of:

1. Fast Healthcare Interoperability Resources (FHIR). ONC proposed that EHR systems would have to allow access to data using APIs built with FHIR, a common, industry-established standard. This would enable technology developers to access individual pieces of information—such as a list of medications—instead of a broader document containing more data, some of which might be unnecessary. By one estimate, more than 80 percent of hospitals and about two-thirds of clinicians already use EHRs with FHIR capabilities. Groups including the American College of Physicians, the Premier health care alliance, the Sequoia Project, and the Health Information Technology Advisory Committee (HITAC) called for APIs using FHIR release 4, the most recent version, which is not expected to change significantly in the near future.
2. Implementation guides. FHIR alone isn’t sufficient for easy extraction of data from EHRs. Effective interoperability also requires technology developers to use implementation guides, which explain how to represent different types of data when the standard allows for variation in how they are represented. For example, FHIR might allow a prescribed drug to be coded in multiple ways. Implementation guidelines can indicate a single way to depict the medication so that it can be more easily understood. Combining FHIR and such guidelines for standard APIs would ensure that these tools can be used to easily and securely request data from other EHR systems and get consistent, predictable responses.
   
   To provide this consistency, ONC proposed requiring that EHR developers use API implementation guidelines from the Argonaut Project, a collaboration among technology developers and health care providers. Although some commenters proposed using alternative guidelines, there was wide recognition from groups like HITAC, the American Medical Association, and the American Medical Informatics Association that using standards-based APIs to improve interoperability will require implementation guidelines.
3. More data. ONC‘s proposal would also mandate that APIs enable access to a wider range of data elements in a patient’s record than they currently do, including the clinical notes that doctors use to describe nuances in an individual‘s medical condition or details of their treatment plans. Doctors need this information to make better decisions, and research suggests that reading these notes also helps many patients understand and follow through with treatment.
   
   Organizations like the CARIN Alliance, which aims to give consumers more control over who sees their health information, and the American Academy of Neurology backed these provisions in their comments. The SMART Health IT Project and the American College of Cardiology also wrote in support of including more data in the API requirements, including images like X-rays or CT scans.

ONC’s proposed API requirements, along with an approximately two-year timeline for Medicare providers to implement them, meet the vision that Congress set three years ago to improve health IT interoperability. Finalizing these rules would launch a new era for EHRs, one powered by standardized APIs that let patients and health care providers access more data than before, using the same internet-based tools that have fueled innovation in other industries. The sooner this transformation begins, the sooner clinicians and patients will benefit from safer and better-coordinated care.

Ben Moscovitch directs The Pew Charitable Trusts’ health information technology initiative.