“Interoperability” of Electronic Health Data Is a Unicorn

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Having spent $26 billion of taxpayers’ money since 2009 inducing hospitals and physicians to install electronic health records (EHRs), many champions of the effort are dismayed that the EHRs are not interoperable. That is, they cannot talk to each other — which was the whole point of subsidizing the effort.

All this money has achieved a process goal: There has been a significant uptake in EHR adoption. According to a recent review, the proportion of physicians who have at least a basic EHR has increased from under 22 percent to 48 percent. Doctors were motivated by the bounty offered, plus the threat of having reimbursements clawed back in 2015 if they did not adopt EHRs. The proportion of hospitals with EHRs has similarly increased from 12 percent to 44 percent.

But what do these EHRs do? What they do not do is talk to each other. According to the same review, “only 10 percent of ambulatory practices and 30 percent of hospitals were found to be participating in operational health information exchange efforts.”

All those billions of taxpayer dollars are paid out to providers who attest to “meaningful use” of EHRs. However, there are three stages of meaningful use. Stage 1 was easy: Plug it in and turn it on. Stage 2 was originally supposed to be achieved by 2013, but that has been pushed back until 2016. The hang up is that Stage 2 has a high hurdle for interoperability.

According to the final rule published in September 2012, requirements include “the expectation that providers will electronically transmit patient care summaries with each other and with the patient to support transitions in care. Increasingly robust expectations for health information exchange in Stage 2 and Stage 3 would support the goal that information follows the patient.”

Despite the delay, providers are still complaining that the requirements are too demanding. According to Russell Branzell, president and CEO of the College of Healthcare Information Management Executives: “Now the very future of Meaningful Use is in question.”

So it should be: Evidence from Congressional investigations suggests that meaningful-use bounties have encouraged the adoption of EHRs that are deliberately closed to exchange with other parties. The problem is that exchanging data with competitors is fundamentally against the self-interest of the party which created the data. Nobody would expect the U.S. Department of Transportation to set up a fund to incentivize car makers to exchange data with each other, or the U.S. Department of Agriculture to set up a fund to incentivize grocery stores to exchange data with each other.

That is not to say that there would be no value to such data exchange. If Safeway were out of my favorite brand of breakfast cereal, I’d love for the clerk to tell me that Giant had plenty in stock just down the road, instead of selling me something similar. However, the amount of government funding required to overwhelm competitors’ resistance to doing this would surely not be worth it.

The same goes for health information exchange: $26 billion has not done the trick. It is unlikely that the remaining $4 billion in the pot will get the job done. The Office of the National Coordinator of Health IT has been promoting a ten-year plan for more funding — even a trust fund like the Federal Highway Trust Fund!

Congress should be very skeptical of appropriating yet more funding to hunt this unicorn.

By John R. Graham, National Center for Policy Analysis, September 3, 2014.
Provided by Carl C. Schuessler, Jr., DHP, DIA, GBDS, of, BenefitStrategies, LLC (404-941-5519 or carl@benefitstrategiesllc.com).

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