With Stage 2 waiting in the wings, the focus is now shifting onto the electronic capture of health information and fostering data exchange at points of care transitions, said Shahid Shah, software analyst and author of the blog, The Healthcare IT Guy. And unlike meaningful use Stage 1, Stage 2 is looking to "raise the bar" and require true interoperability. 

"Current generation EHRs already do some, if not most, of the requirements recommended for Stage 2," he said. "But the reason they won’t meet or exceed the requirements of modern interoperability is [because] next-generation EHRs need far more sophisticated integration capabilities, not just basic interoperability between systems as suggested by the MU Stage 2 NPRM." 

Shah outlined 12 integration capabilities the next-generation of EHRs will need to have. 

1. Single sign-on (SSO) using SAML and other commercial industry standards. One attribute of applications, particularly mHealth apps, said Shah, is they proliferate. "You start with one small one, then another, and then more," he said. "That's exactly what should happen, because healthcare is complex and needs [a lot] of solutions." But, he continued, if you don't manage user authentication and authorization centrally, while allowing people to switch between these applications using a common login and password, you'd soon have applications that users don't want to use. Luckily, he said, there are a myriad of options for "common authentication and single sign-on, such as SAML and CAS … your next-generation EHR should include an industry-standard SSO capability." 

2. Patient context awareness and context transitions between apps. As applications proliferate and you need to integrate them into an EHR system, Shah said, you'll realize that, even if you have Single Sigh On in place, you will lose the context – or the "active patient" or "active task" being performed – unless you understand how to track patient context and transition of context between the applications. "There are a few good approaches, such as CCOW," he said. "You can start with [that], but, allowing your EHRs to be controlled through custom APIs is a great approach, too." 

3. Publishing widgets. According to Shah, next-generation EHRs should allow the ability to "publish" their features as widgets, through proper authorization and authentication, as well as single sign-on. "As Wikipedia notes, a widget is a 'generic type of software application, comprising portable code,' which, 'implies that either the application, user interface, or both, are light, [or] relatively simple and easy to use,'" he said. "EHRs often have hundreds of functions, and if some, or many, of those functions are exportable or publishable as 'widgets,' then they become much easier to integrate into new user interfaces in the future." 

[See also: Epocrates drops plans for EHR.]

4. Consuming widgets. "Some forward-leaning EHR vendors already know how to consume basic widgets that are already published across the web," said Shah. "Next-generation EHRs will need to do so in a sophisticated and easier manner than the current offerings allow." Future EHRs, he continues, will become more like containers of cross-application functionality, instead of innate functionality. "So consuming widgets will be a basic requirement," he said. 

5. Mash-ups, with or without CMIS. To Shah, EHRs are "really nothing more than fancy content management systems (CMS) or document management systems (DMS)." According to him, next-generation EHRs should allow access to their content through the "relatively mature" content management interoperability services (CMIS) standard. "The CMIS specification provides a Web service interface that is designed to work over existing repositories, enabling customers to build and leverage applications against multiple repositories." In turn, this allows customers to unlock content they already have in their various health record solutions. "EHRs with good CMIS interfaces provide common Web services and Web 2.0 interfaces to dramatically simplify application development," he said. 

6. Customizable dashboards. With proper single sign-on, patient context awareness, widgets and mash-up capabilities, future EHRs will be able to provide "sophisticated and highly customizable dashboards that can be tailored by user, by user role, by organization, or [by] other rules," he said. 

Continued on the next page.