Electronic Health Records: Is There Any Hope for Interoperability?


Electronic Health Records: Is There Any Hope for Interoperability?

The goal of having health information travel with the patient is not being achieved

By Sue Montgomery, RN, BSN, CHPN
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Continuity of Care is one of the major  reasons that the electronic health record (EHR) holds value. The ultimate goal is interoperabilty — the ability to pass patient information from one system to the next so that the record can follow the patient wherever he or she goes.                     

Unfortunately, as noted in a public scolding almost a year ago from the Office of the National Coordinator for Health IT (ONC), interoperability efforts continue to be stalled.

With so much at stake, the ongoing delays can be perplexing. A number of factors are contributing to the sluggish progress. Here, we’ll take a look at how they’re being addressed.

An Information Logjam

That scolding from the ONC, co-written by National Coordinator for Health IT Karen DeSalvo, M.D., MPH, M.S., followed an April 2015 report to Congress that called out “information blockers”: “persons or entities [who] knowingly and unreasonably interfere with the exchange or use of electronic health information.”

Who are the most common information blockers? According to that report, most of the complaints the ONC receives involve health IT developers. The most frequent charge:  “that developers charge fees that make it cost-prohibitive for most customers to send, receive or export electronic health information stored in EHRs or to establish interfaces that enable such information to be exchanged with other providers, persons or entities.”

More recently, DeSalvo shared her vision for 2016: for her agency to connect the country’s health information exchanges by the end of the year as a step towards achieving nationwide interoperability. “We have built … an infrastructure in this country where essentially every state has a health information highway,” she says. “Our goal is to see that we can connect those highways … in the entire country within a year.”

To do it, she says those involved will have to adhere to three “commitments”:

  • Collaboratively develop standards for interoperability
  • End information-blocking practices
  • Provide consumers access to their health information and the ability to share it.

Is Competition Between Vendors the Culprit?

One EHR provider that is often accused of being unwilling to share is the massive Epic, which claims to manage medical records for 56 percent of Americans. The company was sharply criticized by a 2014 RAND report on interoperability, was required to answer questions before Congress and received a blasting in a recent Mother Jones piece.

Epic shot back in response to the last, noting that the company just received the No. 1 ranking in a 2015 interoperability study conducted by the research firm KLAS. That report praised Epic’s highly respected interoperability team, although KLAS noted that Epic’s principal weakness is its perceived inflexibility.

The other nine vendors in the top 10 (in descending order) — athenahealth, Cerner, MEDITECH, Greenway Health, NextGen, Allscripts, eClinicalWorks, GE Healthcare and McKesson — each had an array of strengths and weaknesses as well.

What’s interesting to note is that five of those nine are founding members of the growing CommonWell Health Alliance. The organization is a cooperative effort that was created in response to the interoperability challenges that are caused in part by competition among vendors. Epic is not a member.

Don’t Blame the EHR

In an era of hand-wringing over the massive amount of money ($31 billion so far) spent on the EHR incentive program — and finger-pointing between providers, EHR vendors and even the government — it’s refreshing to hear another take on the matter altogether.

In a recent article for Healthcare IT News, Drew Schiller, chief technology officer and cofounder of Validic, an award-winning data aggregator, said it is a mistake to place sole responsibility for interoperability on EHR systems.

“EHR vendors are unfairly blamed for the fact that healthcare is not more interoperable,” he wrote. “Changes to physician workflow and new models of care … are necessary for interoperability to be fully achieved.”

Since Validic won Frost & Sullivan’s 2014 Best Practices Global Healthcare Information Interoperability Customer Value Leadership Award for their mHealth interoperability solution, Schiller knows something about what it takes to make effective interoperability a reality.

I asked him what changes he feels are needed in the healthcare industry in order to achieve greater interoperability progress. He says that while he thinks technology is key, it’s not the only factor. “[W]e need shifts in provider practice and willingness to build care programs utilizing this technology,” he says. “Too often care teams are spending their time calling other providers about patient records, faxing paper records and trying to coordinate care efforts across a disjointed and disconnected system. This is a drain on our resources that could be better spent on care and with patients.”

Schiller believes interoperability must ultimately be a team effort. “We need all stakeholders — patients, physicians, technology companies, providers and payers — to be involved to help drive interoperability and make it a reality,” he says.

California’s Interoperability Leadership

Like other states, California has a number of health information exchange (HIE) organizations. Within this region, there are several significant collaborative initiatives underway, including the California Data Use and Reciprocal Support Agreement signed in July 2014 by nine of the state’s HIEs.

There is also the recently established California Integrated Data Exchange, or Cal INDEX, a nonprofit organization founded by Blue Shield of California and Anthem Blue Cross to improve secure data-sharing between payers and providers. Dignity Health announced in December that it was jumping on board Cal INDEX as well.

In addition, the California Association of Health Information Exchanges and the National Association for Trusted Exchange recently announced that they are beginning work on a new trust community for Direct messaging among providers nationwide.

Hope on the Horizon

In December, Congress received a new report—this one from the Health IT Policy Committee, which advises the ONC. Entitled Challenges and Barriers to Interoperability, the report makes four recommendations with an eye towards further federal involvement:

  1. Develop and implement meaningful measures of HIE-sensitive health outcomes and resource use for public reporting and payment
  2. Develop and implement HIE-sensitive vendor performance measures for certification and public reporting
  3. Set specific HIE-sensitive payment incentives that incorporate specific performance measure criteria and a timeline for implementation that establishes clear objectives of what must be accomplished under alternative payment models
  4. Convene a working summit of major stakeholders co-led by the federal government … and the private sector to act on the ONC Interoperability Roadmap to accelerate the pace of progress towards interoperability.
  5. In an effort to avoid additional government oversight, 12 EHR vendors — including three of the largest: Epic, Cerner and MEDITECH — recently came together to create a set of common metrics to assess the interoperability of their products and make health information exchange easier.

KLAS Founder and Chairman Kent Gale, whose firm organized the summit where those metrics were developed, told Marianne Kolbasuk McGee of HealthcareInfoSecurity.com, “The vendors think it’s valuable to collaborate and unify themselves around an approach to improve interoperability rapidly so that we don’t have to rely on the government to set the rules and the guidelines.”

If there is any hope to be found on the interoperability horizon, it will exist in such collaborative efforts as these.

Although interoperability that enables open and secure health information exchange may seem to be a simple and straightforward task, nothing could be further from the truth. For the sake of the patients we serve — and the sanity of healthcare providers everywhere — that will hopefully change in the near future.  



Defining Levels of Interoperability

1. “Foundational”
        Allows one healthcare IT system to receive data from another, but not
    necessarily to be able to understand or process that data.

2.  “Structural”
        Enables healthcare data exchange between IT systems that preserves the
         data’s “clinical or operational purpose and meaning.”

3.  “Semantic”
        Allows multiple IT systems to both share and use healthcare data from
        each other’s system.

Source: Healthcare Information and Management Systems Society


Health Information Exchange: Both Verb and Noun

Verb ◗ To provide the interoperable data, infrastructure and technology for the exchange of data between and among healthcare providers who are not structurally or organizationally related to one another.

Noun ◗ An organization formed as a corporate entity to provide services that include data exchange and sharing of patient data among disparate stakeholders at the local, state, regional and national levels.

Source: Healthcare Information and Management Systems Society


California Interoperability Resources


Sue Montgomery, RN, BSN, CHPN, is a healthcare writer, editor and consultant specializing in end-of-life issues, digital health and bioethics.


This article is from workingnurse.com.

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