Improving Healthcare Through Effective EHR Standards

Have you ever struggled to get your medical records transferred between doctors’ offices or healthcare systems? Or tried to piece together your full health history when no one provider has the full picture? 

For patients and providers alike, fragmented, inaccessible data has long posed a major frustration and barrier to quality care. But the era of digitized medicine offers new hope for connectivity and continuity of care—if healthcare organizations can get on the same page.

That's where standardized electronic health records (EHRs) come in. By adhering to common guidelines and criteria, EHR systems can “talk” to each other, enabling the seamless, secure exchange of patient information. Critical details like medications, diagnoses, labs, imaging, and procedures can follow individuals wherever they go, supporting better-informed, coordinated care.

Yet effective standards don’t happen by accident. Behind the scenes, numerous entities work rigorously to define, implement, regulate and update EHR standards across the sprawling, complex healthcare ecosystem. 

This coordinated effort is the key to unlocking the full potential of digitized health data to improve care quality, cost-efficiency and patient outcomes.

Driving Nationwide EHR Adoption

In 2004, the Office of the National Coordinator for Health Information Technology (ONC) was established under the Department of Health and Human Services (HHS) to oversee and coordinate nationwide adoption of EHRs. Recognizing the pivotal role that standards play, ONC has spearheaded initiatives to:

• Set goals and timelines for EHR deployment
• Define functional and technical criteria that EHR systems must meet
• Create programs and incentives to drive standards adoption
• Certify EHR products to ensure standards compliance
• Enable health information exchange between disparate systems

A major milestone came with the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which called for the “meaningful use” of EHRs. To that end, ONC worked closely with the Centers for Medicare and Medicaid Services (CMS) to launch the Medicare and Medicaid EHR Incentive Programs in 2011. These programs defined progressive standards in three stages for how EHRs must be used to improve care, with financial rewards given to compliant providers.

This represented a tipping point, spurring investments in certified EHR systems. As Eligible Professionals and Eligible Hospitals attested to meeting Meaningful Use objectives, EHR adoption surged. By 2017, 86% of office-based physicians and 96% of hospitals had implemented certified health IT systems.

Central to the meaningful use vision was ensuring that EHRs could share information securely—a prerequisite for coordinated care and improved health outcomes. Hence interoperability and health information exchange figured prominently in the required standards. 

Other criteria focused on patient engagement, safety, care coordination, population health management and clinical quality reporting.

Key Objectives Across Stages of Meaningful Use

Stage 1 Objectives	Stage 2 Objectives	Stage 3 Objectives
Electronically capturing health information in a standardized format	More rigorous health information exchange and interoperability	Improving quality, safety and efficiency with decision support, patient access and medical information reconciliation
Implementing drug-drug and drug-allergy interaction checks	Empowering patients with online access to health information	Reporting on advanced clinical quality measures, public health data and resource use
Maintaining active medication and allergy lists	Strengthening clinical processes like e-prescribing and test result tracking	Focusing on improved outcomes via patient-centered coordinated care
Using EHRs for care planning, ordering, viewing lab results, messaging	Reporting clinical quality measures and public health data	Leveraging application programming interfaces (APIs) for data access and exchange

Key Milestones:

• Stage 1: Focused on electronically capturing and sharing health data (2011 - 2012)
• Stage 2: Advanced clinical processes and information exchange (2014 - 2016)
• Stage 3: Improved outcomes through patient engagement, coordination and quality measurement (2017 onward)

Through this staged approach, Meaningful Use drove measurable improvements on multiple fronts while familiarizing providers with certified systems, accelerating standards adoption. 

Although the Medicare and Medicaid EHR Incentive Programs ended in 2021 after disbursing over $38 billion in rewards, the solid standards foundation they fostered continues shaping healthcare’s digital trajectory.

Defining the Nuts and Bolts of EHR Standards

But what specifically constitutes “EHR standards”? That’s where organizations like Health Level Seven International (HL7) come into play. HL7 focuses on developing comprehensive standards, guidelines and methodologies for the structured, coded exchange, integration, sharing and retrieval of electronic health data. These serve as the nuts and bolts enabling EHR systems integration and interoperability.

HL7 standards span clinical and administrative data including:

• Patient demographics
• Vital signs
• Diagnoses
• Lab tests and results
• Care plans
• Medications
• Immunizations
• Progress notes
• Discharge summaries
• Billing details

Among the most widely adopted HL7 standards are:

• HL7 Version 2 (V2): Specifies message formats for transaction-oriented data exchange
• HL7 Version 3 (V3): Focuses on communication for enterprise integration and semantics
• HL7 Fast Healthcare Interoperability Resources (FHIR): Supports flexible data exchange via modern web standards
• Clinical Document Architecture (CDA): Provides document markup standard for clinical notes

These complement other important standards including:

• ICD-10: International Classification of Diseases for medical diagnosis and procedure coding
• LOINC: Universal code system for identifying medical laboratory observations
• SNOMED CT: Terminology for electronic medical record concepts
• DICOM: Digital imaging and communications in medicine standard

Mastering this “alphabet soup” of protocols enables the structured capture, storage and transmission of health data between diverse systems. It allows medical histories to flow across providers, regardless of where or by whom care was delivered.

Certification and Compliance: Ensuring Standards Uptake

Defining standards is one thing. But how is adherence verified? Again, a multilayered approach across public and private entities aims to uphold rigor.

The ONC oversees EHR product certification through its Office of the National Coordinator for Health Information Technology Certification Program (ONC Health IT Certification Program). Software developers voluntarily submit products for certification testing by ONC Authorized Testing Labs. Those meeting criteria are ONC Certified and listed on the Certified Health IT Product List.

Certification aims to verify EHR systems’ ability to:

• Record, manage and share structured patient data according to standards
• Support secure clinical information exchange and care coordination
• Report on quality measures and public health objectives
• Provide clinical decision support, patient education resources and data access
• Perform drug-drug and drug-allergy checks and other safety functions
• Enable e-prescribing and other digital processes

To maintain certification, developers must adhere to ongoing standards evolution and requirements as stipulated by ONC. This encourages product enhancement supporting advanced interoperability.

Yet responsibility does not end with vendors. Healthcare organizations must properly implement certified systems along with associated policies, workflows and training that enable meaningful use. 

The Office for Civil Rights (OCR) enforces HIPAA regulations governing security and privacy of patient health data. Providers found noncompliant may face fines or corrective action plans.

Meaningful use audits by CMS evaluated providers’ standards application, assessing factors like:

• Patient data capture and exchange
• Clinical decision support utilization
• Computerized order entry processes
• Secure messaging capabilities
• Patient education resource provisions
• Public health and clinical quality reporting

Those failing to meet requirements faced Medicare/Medicaid reimbursement penalties.

Compliance resembles a three-legged stool, supported by:

1. Vendor development and maintenance of certified EHR systems
2. Healthcare organization diligent and skillful application of those systems
3. Ongoing oversight, auditing and enforcement mechanisms

This end-to-end accountability aims to uphold the integrity and maximum benefits of standardized EHR systems.

The Road Ahead: Realizing the Promise of Digitized Health

The path to optimized, interoperable EHR systems requires diligence from all healthcare stakeholders. As standards continue evolving, organizations must stay up-to-date to realize the promise of seamless, ethical data exchange.

For medical practices and clinics, choosing the right EHR platform is essential. Calysta EMR provides a comprehensive solution designed for smooth practice management and robust data connectivity.

From operations to patient data and suppliers to client communication, Calysta consolidates everything in one HIPAA-compliant platform. As a cloud-based system, it ensures real-time synchronization across users so you always have access to the latest information when making clinical decisions.