Newtown, CT – April 17, 2015
Breaking News: Government Report Slams EHR Vendors and Providers For Colluding to Block Health Information….In the inimitable words of Gomer Pyle, surprise, surprise, surprise – At this week's annual kumbaya fest of the recipients of one of the biggest handouts in the history of the United States, there was an underlying feeling of shame that the hundreds of billions of dollars spent by taxpayers to encourage the adoption of electronic medical records, had resulted in the creation of impenetrable fortresses of health information to the benefit of health systems, instead of an interoperable highway of health data that could benefit patients and the country. And they should be hanging their heads in shame, but they're not the only ones. After all, the trillion plus funneled to providers and, consequently to EMR vendors, was done by federal officials who mind-numbingly failed to impose any type of requirement for true interoperability. Faced with this embarrassment, the new head of the Office of the National Coordinator for Health Information Technology indicated that she couldn't do much about it. Yes folks, believe it or not, the head of the government agency that is responsible for setting the rules that govern the handouts indicated that she couldn't require EMR vendors to have interoperable systems. How's that for incompetence.
What this means to you – before you fully despair, note that some of the vendors who have coalesced into an industry group of sorts controlling a proprietary health information exchange voluntarily decided to stop charging fees for information exchange coming from their EMRs. They didn't say anything about other vendors' EMRs. And EPIC, the vendor most responsible for the sorry and purposeful state of non-interoperable EMRs, magnanimously declared they would waive the fees charged today for facilitating a vague degree of information exchange. They can afford to be magnanimous with the billions that they have amassed at the expense of every taxpayer. But I actually don't blame the vendors. After all, they, and their customers, were simply responding to the incentives at play. The government was providing a handout with few strings attached, and the providers were busy consolidating in response to the underlying fee-for-service and total cost of care incentives. The basic fact is that both of these modes of payment discourage information sharing outside a provider's wall, and until the payment incentives change, there's no reason to expect more information sharing. However, at this point, and with the locked systems that many have created, what new policy should the government consider to push through real health data information sharing. In an upcoming report sponsored by the Robert Wood Johnson Foundation on the State of HIT in the US in 2015, we argue that the enforcement of semantic interoperability holds the key to freeing up health data for providers to actively manage patient health inside and outside the closed walls of a health system. So there is a way out of this mess, but it's sad that, once again, we find ourselves having to dig out from underneath poorly thought out and poorly executed federal policy.