National standards for health data exchange permit too much variability and must be tightened, a family practitioner told a federal advisory board on Oct. 29. The implementation workgroup of the HIT Standards Committee is taking testimony from providers, vendors, quality measures experts and others on the challenges of implementing health information systems and exchanging data.

Floyd Bradd, M.D., founder of Skyline Family Practice in Front Royal, Va., gave several examples of the challenges of automating and the need for standardized standards. In written testimony, he explained the frustrations of establishing interfaces with labs:

"The interface process is different for each laboratory company. Even if they use the standard ASTM format, they interpret it in different ways and use a different terminology for individual lab tests. This then requires separate identifiable costs and processes to configure those interfaces. This is obviously a strain on any practice but in particular a small practice. Sometimes, even the same laboratory company will have regional differences in how they implement a lab interface for their particular customer. It is important that a single standard for laboratory data be selected nationally. Additionally, there should be an implementation guide that prevents variation within the standard with standardized terminology."

Bradd recalled his three-physician practice suffering a significant loss of cash flow over a two-month period when converting to electronic claims submission in 2005:

"This was due to the fact that although there was a standard for electronic submission of claims, the interpretation and implementation of those standards was left up to the third-party carriers. As a result, there were data fields that were different amongst different carriers. The delays in refining the different claims needs of the carriers caused us to nearly 'go under' financially. Things are working fine now, but not without that initial difficulty due to lack of fully standardized interoperability. I hope this example highlights the need for a clear and 'locked down' standard that will not be subject to interpretation or alteration by people/entities for their own needs."

Bradd also described the difficulties physicians have with connecting to local hospitals to receive patient data:

"Some hospital systems frankly ignore the importance of interoperability with smaller practices. Other systems decide on an EHR which they will support with a 'take it or leave it' approach. In other words, either you get that EHR the hospital supports or you will be left out to fend for yourself. Sure, helping hospital systems finance the interfacing with all practices who have certified EHRs will help. However, more important would be having a standard communication interface for clinical data."

For Bradd's complete testimony and the testimony of other organizations, click here.

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