In order to fully realize the promise of electronic health records, medical practices must be able to exchange patient records with other practitioners and care settings treating a common patient. It's a concept known as interoperability. Forum Editor Jean Fisher Brinkley asked Holt Anderson, executive director of the NC Healthcare Information and Communications Alliance in RTP, to explain it in plain terms.

Q: What is interoperability?
A: In the healthcare context, interoperability is when you have the ability to share information about a patient between different care settings so that the data that is sent, is received and interpreted as it was originally intended. There is no loss in translation between systems.

Q: Why should physicians and other practitioners care about interoperability?
A: Physicians are driven professionally to provide the best care possible. In today's world, where information is dispersed among different care settings, making a clinical decision without complete information is not giving the best care possible. The only way clinical decisions can be informed is if they can get the information from other systems. And unless these other systems have the ability to talk to each other the information is not going to be there when it's needed.

Q: How close is that to being reality?
A: I think we've made great progress over the last few years with the establishment of the Office of the National Coordinator for Health Information Technology (ONC). Its role is to establish standards that can be adopted by companies that develop and sell electronic health records and by companies that focus on exchanging information between systems. Those standards are now established and they are beginning to emerge. The ability to exchange information is based on being built on the same standards. In order to receive stimulus money for EHR, physicians must purchase a system that is certified to be interoperable. The government is now beginning to certify certifying entities so that physicians making decisions can be assured that they are purchasing a system that is interoperable.

Q: Where are we today in North Carolina?
A: In comparison to other states I think we’re very fortunate in having five academic medical center-based integrated delivery networks with very robust physician referral networks. I’m thinking of the UNCs, the Dukes, the East Carolinas. They’re very automated and they're all totally integrated. Then we have the Novants and the WakeMeds and the other health systems in the state that are also very good and very automated. We have practices and large clinics that are also very automated, so that’s at one end of the spectrum. At the other end of the spectrum we have many solo practitioners and small practices, primarily in rural settings. We have pediatricians and family medicine doctors, who have very slim margins in the first place, who can’t afford, necessarily, the investment that’s required for getting EHR. The new stimulus funding is an opportunity to get that.

Q: What do physician practices have to do in order to be interoperable, other than buy a certified system?
A: There have to be agreements among a practice or physician’s office and the organizations they want to do business with and trade records with. The expectations and responsibilities of partners who want to exchange information need to be memorialized. If I’m going to exchange records with you and you’re going to make decisions based on the information I’m sending you, where is my liability and where is your liability? What is your responsibility for responding to me if I request records? Can I charge you? What can I expect from you, now that we’re sharing a patient? It’s actually much more complex. The technology piece is the easy piece.