School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
J Am Med Inform Assoc. 2022 Apr 13;29(5):753-760. doi: 10.1093/jamia/ocab289.
Electronic health records (EHRs) contain a large quantity of machine-readable data. However, institutions choose different EHR vendors, and the same product may be implemented differently at different sites. Our goal was to quantify the interoperability of real-world EHR implementations with respect to clinically relevant structured data.
We analyzed de-identified and aggregated data from 68 oncology sites that implemented 1 of 5 EHR vendor products. Using 6 medications and 6 laboratory tests for which well-accepted standards exist, we calculated inter- and intra-EHR vendor interoperability scores.
The mean intra-EHR vendor interoperability score was 0.68 as compared to a mean of 0.22 for inter-system interoperability, when weighted by number of systems of each type, and 0.57 and 0.20 when not weighting by number of systems of each type.
In contrast to data elements required for successful billing, clinically relevant data elements are rarely standardized, even though applicable standards exist. We chose a representative sample of laboratory tests and medications for oncology practices, but our set of data elements should be seen as an example, rather than a definitive list.
We defined and demonstrated a quantitative measure of interoperability between site EHR systems and within/between implemented vendor systems. Two sites that share the same vendor are, on average, more interoperable. However, even for implementation of the same EHR product, interoperability is not guaranteed. Our results can inform institutional EHR selection, analysis, and optimization for interoperability.
电子健康记录（EHR）包含大量可机读数据。然而，各机构选择的 EHR 供应商不同，同一产品在不同地点的实施方式也可能不同。我们的目标是量化实际 EHR 实施在临床相关结构化数据方面的互操作性。
我们分析了来自 68 个实施了 5 种 EHR 供应商产品之一的肿瘤学站点的去识别和汇总数据。使用 6 种药物和 6 种存在公认标准的实验室检测，我们计算了 EHR 供应商内部和之间的互操作性得分。
与系统间互操作性的平均值 0.22 相比，在按每种类型系统数量加权时，EHR 供应商内部互操作性的平均值为 0.68，而在不按每种类型系统数量加权时，平均值分别为 0.57 和 0.20。
与成功计费所需的数据元素相比，临床相关数据元素很少标准化，即使存在适用的标准。我们选择了肿瘤学实践中具有代表性的实验室检测和药物样本，但我们的数据元素集应被视为一个示例，而不是一个确定的列表。
我们定义并演示了站点 EHR 系统之间以及实施的供应商系统内部/之间互操作性的定量度量。共享同一供应商的两个站点平均更具互操作性。然而，即使实施相同的 EHR 产品，也不能保证互操作性。我们的结果可以为机构的 EHR 选择、分析和优化互操作性提供信息。
