Are Meaningful Use Stage 2 certified EHRs ready for interoperability? Findings from the SMART C-CDA Collaborative.

Area of Science:

• Health Informatics
• Clinical Data Standards
• Interoperability Research

Background:

• Upcoming 2014 US Electronic Health Record (EHR) system upgrades aim to improve care provider document exchange.
• The Meaningful Use program mandates Consolidated Clinical Document Architecture (C-CDA) for EHR document exchange.
• The SMART C-CDA Collaborative convened EHR vendors to assess and enhance C-CDA exchange.

Purpose of the Study:

• To evaluate the semantic correctness and consistency of machine-readable C-CDA documents.
• To identify barriers to effective C-CDA based document exchange.
• To explore practical improvements for C-CDA document quality and exchange.

Main Methods:

• Collected 91 C-CDA sample documents from 21 health information technologies.
• Performed automated parsing (BlueButton.js), validation, and scoring.
• Conducted manual inspection and vendor review sessions to understand C-CDA interpretation.

Main Results:

• Identified 615 errors and data expression variations across technologies.
• Determined 11 specific areas hindering C-CDA document interoperability.
• Found significant heterogeneity in C-CDA document implementation.

Conclusions:

• Errors and permissible heterogeneity in C-CDA documents limit semantic interoperability.
• Practical opportunities exist to enhance C-CDA document quality and exchange.
• Addressing identified barriers is crucial for successful EHR interoperability.