Interoperability of EHR-systems - certification criteria and communications standards

AUTHORS: Engelbrecht R

INSTITUTIONS: GSF National Research Centre for Environment and Health, Munich-Neuherberg, Germany, EuroRec-Institute/ProRec centre Germany

BACKGROUND: The Electronic Health Record (EHR) has evolved to become centre-stage in the national health informatics strategies of most European countries. There is a need for interoperability standards that can permit clinical computer systems to share health record data whilst preserving faithfully the clinical meaning of the individual authored contributions. EHRs primary function is documentation and communication of patients’ data. Having access to comprehensive, interoperable and secure EHRs has been shown to improve quality of care and patient safety. EHR buyers (e.g. physicians and hospital directors) highlight that EHR systems and related product quality, data portability and interoperability are difficult to judge. Voluntary certification of Electronic Health Record systems is a powerful mechanism to ensure that EHR systems are robust enough to deliver those anticipated benefits.

OBJECTIVE: Certification reduces the risk for purchasers and therefore accelerates the adoption of high quality and more interoperable EHRs. Several EU-member states (Belgium, Denmark, UK, Germany, ...) have already proceeded with quality labelling and certification schemes, but they differ in scope, in legal framework under which they operate, in policies, in organisation, in the choice of quality conformance criteria for benchmarking and testing. These differences represent a risk of further market fragmentation: harmonisation efforts should help us to avoid this!

METHODS: A model of certification criteria was established based on the experiences from EU-member states and international activities. It builds on the output from the harmonisation of existing certification systems in Europe, be informed by emerging certification schemas in a world wide context and takes account of local variations in the different European member states, including legal implications.

CONCLUSION: The model addresses the requirements concerned with data and systems architecture, interoperability standards, data access, functionality, security and communication and will cover both the primary care and the acute hospital care setting. The short term Strategy is:
- Collect high priority criteria from existing systems
- Choose a reasonable set of instances
- Encode these instances in our formal (indexing) model
- Analyze how they can interact with our certification procedures
- Warehouse the agreed guidelines and criteria
- Streamline and automate the certification procedure
- Validate the whole system through pilots
There is a set of impacts to be expected. A major impact is to foster availability, accessibility, interoperability and portability of the patient records no matter where the patients are located in a health care setting or are travelling.

REFERENCES:
1. http://www.prorec-de.org
2. http://www.eurorec.org