title: Are Meaningful Use Stage 2 certified EHRs ready for interoperability? Findings from the SMART C-CDA Collaborative.
abstract: OBJECTIVE
  Upgrades to electronic health record (EHR) systems scheduled to be introduced in the USA in 2014 will advance document interoperability between care providers. Specifically, the second stage of the federal incentive program for EHR adoption, known as Meaningful Use, requires use of the Consolidated Clinical Document Architecture (C-CDA) for document exchange. In an effort to examine and improve C-CDA based exchange, the SMART (Substitutable Medical Applications and Reusable Technology) C-CDA Collaborative brought together a group of certified EHR and other health information technology vendors.
  
  
  METHODS
  We examined the machine-readable content of collected samples for semantic correctness and consistency. This included parsing with the open-source BlueButton.js tool, testing with a validator used in EHR certification, scoring with an automated open-source tool, and manual inspection. We also conducted group and individual review sessions with participating vendors to understand their interpretation of C-CDA specifications and requirements.
  
  
  RESULTS
  We contacted 107 health information technology organizations and collected 91 C-CDA sample documents from 21 distinct technologies. Manual and automated document inspection led to 615 observations of errors and data expression variation across represented technologies. Based upon our analysis and vendor discussions, we identified 11 specific areas that represent relevant barriers to the interoperability of C-CDA documents.
  
  
  CONCLUSIONS
  We identified errors and permissible heterogeneity in C-CDA documents that will limit semantic interoperability. Our findings also point to several practical opportunities to improve C-CDA document quality and exchange in the coming years.
authors: Lantana Consulting Group, LLC, East Thetford, Vermont, USA Diameter Health, Inc., Newton, Massachusetts, USA.
authors: John D
authors: JD
authors: D'Amore
authors: Children's Hospital Informatics Program at Harvard-MIT Health Sciences and Technology, Boston, Massachusetts, USA Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
authors: Joshua C
authors: JC
authors: Mandel
authors: SMART Platforms Project, Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.
authors: David A
authors: DA
authors: Kreda
authors: Lantana Consulting Group, LLC, East Thetford, Vermont, USA.
authors: Ashley
authors: A
authors: Swain
authors: Lantana Consulting Group, LLC, East Thetford, Vermont, USA.
authors: George A
authors: GA
authors: Koromia
authors: Lantana Consulting Group, LLC, East Thetford, Vermont, USA.
authors: Sumesh
authors: S
authors: Sundareswaran
authors: Lantana Consulting Group, LLC, East Thetford, Vermont, USA.
authors: Liora
authors: L
authors: Alschuler
authors: Lantana Consulting Group, LLC, East Thetford, Vermont, USA.
authors: Robert H
authors: RH
authors: Dolin
authors: Children's Hospital Informatics Program at Harvard-MIT Health Sciences and Technology, Boston, Massachusetts, USA Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.
authors: Kenneth D
authors: KD
authors: Mandl
authors: Children's Hospital Informatics Program at Harvard-MIT Health Sciences and Technology, Boston, Massachusetts, USA Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.
authors: Isaac S
authors: IS
authors: Kohane
authors: Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
authors: Rachel B
authors: RB
authors: Ramoni
mesh_terms: D002568:Certification; D004059:Diffusion of Innovation; D057286:Electronic Health Records / Q000592:standards*; D062527:Meaningful Use / Q000331:legislation & jurisprudence; D008498:Medical Record Linkage; D016347:Medical Records Systems, Computerized; D018511:Systems Integration; D014481:United States
keywords: C-CDA; Data Exchange; EHR; Interoperability; Meaningful Use