The Cure for EHR Interoperability – More Fed Mandates and Incentives?
Ubiquitous Healthcare Integration is Possible
I must be nuts, right? But give me a minute to explain. EHR vendors lobbied long and hard for the federal Meaningful Use programs that incentivized providers to buy their products, and providers did. According to the Centers for Medicare & Medicaid Services (CMS) at the end of 2013, $19.2 billion was paid out in incentives by the Federal Government. Note, the Office of the National Coordinator for Health IT lists 623 vendors on their Certified Health IT Product List (all poised to share a piece of the big federal pie).
Clearly, the federal mandates and incentives to push along Meaningful Use requirements have created many competing EHR companies and most of them have profited handsomely.
But now that many of these certified companies have sold their products to providers, are the purported benefits of Meaningful Use are being realized? Not at the rate hoped and incentivized for. And certainly not in our experience.
Data Tells Us Few Meaningful Use Goals Have Been Met
Many vendors have delivered products without the required interoperability to make them useful. And let’s not forget the whole purpose was to provide “Meaningful Use” after all. Others provide EHR implementation with internal systems, but as relayed in a recent Klass study, Epic HIE 2014 Everywhere, Elsewhere, or Nowhere Else?, they are often inflexible and, on top of that, make their data inaccessible to outside vendors and their systems. Seamless healthcare interoperability has certainly not been achieved.
Let’s look at some of the numbers that reflect this. While overall EHR adoption surged, the percentage of federally qualified healthcare centers able to electronically share patient data with outside organizations remains disappointing and nowhere near Meaningful Use goals. (Commins, HealthLeaders Media, 5/19/14). Specifically:
- 41% of the centers could electronically share lab results with an outside group
- 37% could share medication lists with an outside group
- 34% could share visit summaries with an outside group
- 33% could share imaging reports with an outside group
Access or Interoperability?
We tell our clients who are outside vendors that our software can connect to anything, if the EHR vendor provides the access. And that’s the big if. The EHRs usually won’t provide easy, if any access. So, it’s not any interoperability issue that’s the roadblock, it’s an access issue.
Why is that the case? As is generally true in business, the underlying driver is financial. EHR providers receive hundreds of thousands of dollars for the interfaces into or from their systems, or for the right to interface with their systems. That creates a disincentive for providers to use competing vendor products and boosts the EHR vendors’ sales. Why would EHR vendors want to stop this gravy train? The situation has also created a new market for intermediary HIEs and HISPS. These allow vendor sharing between EHRs and other outside systems. But it is another example of complexity, dare I say bloat, which is added into the cost of healthcare.
Being that mandates and incentives created this anti-interoperable dynamic, what about mandating interoperability and open access to EHR systems before certifying or recertifying any EHR? Sure, the EHR vendors won’t be making as much revenue due to the loss of interface sales or access fees, but knowing how good ol’ capitalism works, they’ll figure out how to make up for sure. In the meantime, just maybe ubiquitous healthcare integration can move forward. It’s not the optimum solution, but it might have the virtue of common sense.