Certified EHR Systems Not Always Interoperable, Study Finds

July 2, 2014 in News

Electronic health record systems certified under Stage 2 of meaningful use are not always interoperable with other EHR systems, according to a study published recently in the Journal of American Medical Informatics Association, Bloomberg BNA‘s “Health Care Blog” reports (Ruoff, “Health Care Blog,” Bloomberg BNA, 7/1).

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments.

Details of Study

The study was conducted by researchers from the Substitutable Medical Applications and Reusable Technology C-CDA Collaborative, which is funded by the Office of the National Coordinator for Health IT (Durben Hirsch, FierceEMR, 7/1).

For the study, the researchers contacted 107 health IT organizations and gathered 91 Consolidated Clinical Document Architecture sample documents from 21 separate technologies (D’Amore et al., JAMIA, 6/26).

C-CDA is a library of templates that can be used to exchange patient data in both structured and unstructured formats. EHRs must produce C-CDA documents to meet meaningful use Stage 2 requirements (FierceEMR, 7/1).

After collecting the sample documents, researchers:

  • Analyzed them using the open-source Blue Button tool;
  • Tested them with a validator used in EHR certification; and
  • Scored them using an automated open-source tool and manual review. 

In addition, the researchers conducted group and individual review sessions with vendor participants to gauge how they interpreted C-CDA specifications and mandates.


The researchers found 615 mistakes and data expression disparities across the represented technologies, according to the study (JAMIA, 6/26).

The researchers then grouped their observations into 11 trouble areas that create obstacles for EHR interoperability, such as:

  • Misuse or omission of allergic reactions;
  • Omission of medication dose frequency; and
  • Not including results in interpretations (FierceEMR, 7/1).


The researchers offered several recommendations to address the barriers, including:

  • Improved code validation;
  • Providing richer samples in publicly accessible formats; and
  • Reducing data optionality (JAMIA, 6/26).

The study specifically noted that federal officials should change the requirements for meaningful use Stage 2 that relate to the template for recording patient health history. “Without timely policy to move these elements forward, semantically robust document exchange will not happen anytime soon,” the researchers wrote (“Health Care Blog,” Bloomberg BNA, 7/1).

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