Five years ago, only 20 per cent of physicians used electronic medical records (EMRs). Today, 80 per cent use them.
Since the enactment of the HITECH Act, which required that EMRs be adopted across all healthcare providers, the federal government has invested more than $28 billion toward their use.
And, yet, EMR data sharing between disparate vendor platforms, geographically dispersed facilities and unassociated medical institutions remains at a virtual standstill.
Experts at the Healthcare Information Management Systems Society (HIMSS) conference here this week said the industry knows the problem isn't a technological one; it's about the money. By keeping their software proprietary and unable to exchange data, or by actively blocking the use of protocols that would otherwise allow it, vendors can corner their respective markets.
Cris Ross, CIO at the Mayo Clinic, said healthcare interoperability is not a "crisis," it's more like a "perpetual rainy day."
Hospital departments are frustrated because they can't get laboratory reports on time, they can't get radiological images or they don't get complete records.
"We have patients who show up today literally with banker boxes full of paper. And, you know, the job gets done," he said. "We're sort of gutting it out."
About 30% of healthcare expenditures are wasted because the industry isn't following best practices and because of duplication of efforts, Ross said.
Shahid Shah, CEO of research firm Netspective Communications, said that even Congress is aware of the problem after a report last week laid blame at the feet of EMR providers and healthcare institutions.
"The report basically in summary said that there are some folks in the healthcare value chain that are actively blocking the sharing of data," Shah said. "This was completely obvious.... Everybody knew that active blockers are there, and we know many of them here," Shah said. "Unless they're named, hopefully this is step one.... That's when we get to reality. Until we get to reality, we can't solve the problem."
Last week, the Office of the National Coordinator for Health Information Technology (ONC) reported to Congress that despite health information exchange technology being fully baked, data is not being shared among providers.
"Current economic and market conditions create business incentives for some persons and entities to exercise control over electronic health information in ways that unreasonably limit its availability and use," the ONC report said.
The ONC went on to state, "some persons and entities are interfering with the exchange or use of electronic health information in ways that frustrate the goals of the HITECH Act and undermine broader health care reforms."
Being able to exchange healthcare data promises far greater benefits than just the convenience of data mobility. Patient data can be anonymized and used in accelerating scientific research and tracking health trends.
Today, Karen DeSalvo, national coordinator for health information technology, announced new efforts to curtail data blocking, saying the ONC's focus will be on interoperability.
In March, the ONC published its 2015 Edition Health IT Certification Criteria, a set of proposed rules for qualifying EMRs for use. Those rules will be under a public comment period until May 29.
Two weeks ago, the ONC released its proposed rules for "Stage 3" of Meaningful Use of EMRs, which focused on improving how electronic health information is shared and, ultimately, how care is delivered.
Steve Posnack, director of the ONC's Office of Standards and Technology Regulation, said the rules will include surveillance of active blocking.
Posnack said that surveillance will come in two forms: Investigations into complaints and random sampling of EMR software to see if it's baked into the product.
On a related note, the Department of Health and Human Services (HHS) today announced $1 million in new grant programs to help improve sharing of health information in rural and poor areas as well as for entities not covered by its EMS Meaningful Use rules, such as extended care facilities.
Jodi Daniel, director of the ONC's Office of Policy Planning, said the agency will also focus on new medical vocabulary and content standards, and access to data for healthcare providers, patients and their care givers, which may include authorized friends and family.
DeSalvo warned that the ONC is neither an investigative agency nor an enforcement entity, but will instead work with other agencies, such as the Federal Trade Commission and Congress, who can impose fines and other penalties for organizations using unfair competitive practices.
"I think it would be fair to say it's going to take action on the part of the federal government with existing administrative authorities of the private sector, including [EHR] providers and developers to set expectations to set contracts and to have more transparency," DeSalvo said. "If necessary, there may be additional opportunities for Congress to weigh in."
In January, the ONC released a roadmap detailing how it would address interoperability. But revelations that industry vendors and others are actively blocking data sharing may prompt the it to take a more proactive role.
Healthcare experts say technology and standards aren't the problem. As Shah succinctly put it, "We have no healthcare interoperability crisis."
Standards such as the Health 7 International's (HL7) Fast Healthcare Interoperable Resource (FHIR) standard is seeing increased adoption among providers for exchanging patient information.
FHIR (pronounced "fire") is growing in popularity because of its simplicity and ease of use. It's based on RESTful APIs, using the Internet's HTTP protocol and other familiar web specifications such as XML and JSON. It also natively supports leading privacy and security specifications.
Other health information exchange specifications include the Direct Project, a simple, secure, standards-based method for healthcare to share data directly to known, trusted recipients over the Internet. And CONNECT, which is open source software, uses the Nationwide Health Information Network (NHIN) standards and governance to make sure that health information exchanges set up by the government are compatible with other exchanges in the U.S.
"In terms of options, there are many," said Venk Reddy, senior director of Connected Health at Walgreens. "Walgreens supports Connect, Direct, and soon FHIR."
Even health insurance giant Humana's CEO, Bruce Broussard, told a packed auditorium of health IT technologists today that they are not the answer.
"Take the technology we have, and all the things we know to do and take the necessary steps," Broussard said. "Interoperability is the opportunity for us to act like a team."
Broussard illustrated how other industries went through their own interoperability transitions, and while painful and arduous, the end result was well worth it.
Broussard pointed to the financial services industry, and providers such as Charles Schwab, which became the first firm to offer competitors' products.
"Today, it would be unheard of not to offer other products," he said.
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