Thirty billion dollars. Stacked as $100 bills, that would tower well above the weather clouds. Thirty billion dollars grabs plenty of attention. Since 2011, the U.S. Government has spent just that on Electronic Health Record incentives. In 2014, there were over 400 EHR vendors scrambling for a piece of the pie. To put it in perspective, the top five EHR companies only control 48% of the market with scores of companies rounding the majority of market share.**
Not surprisingly, with so many companies in the mix, one truth reigns supreme: EHR systems cannot communicate with each other. In the hospital, medical students, resident physicians, and unit clerks still hover around fax machines hoping to glean a patient's past medical history. Patients carry paper discharge instructions to their primary care office. Of note, hospitals and physician offices are among the very few places where a fax machine can still be found.
How did we get here? To date, there has been little incentive for EHRs to communicate robustly. After all, the weighty transition costs typically lock-in providers, making changing to another EHR less appealing. And as providers seek to capture economies of scale and scope by merging into integrated delivery networks, why would they want to make it easy for patients to leave? In fact, some EHR vendors have been characterized as employing "data blocking" intentionally, charging fees for sharing data with transcription services, interface fees to make data accessible on mobile devices, or tying that data to proprietary systems.
These incentives mean it might be time to change the rules of the game. Mario Hyland, the founder of Information Technology consulting firm AEGIS, frequently engages in these sorts of conversations. He even goes by the Twitter handle @interopguy. Recently, John Lynn, founder of the healthcare IT blog Healthcare Scene, told Mario that EHR vendors should be certified to export all EHR data. Making sure EHR vendors can't hold data hostage would be a solid start.
Fortunately, policy may be catching up with thought leaders. The Office of the National Coordinator for Health Information Technology (ONC) recently submitted a report to congress on data-blocking. It found that interfering with data exchange knowingly, and unjustifiably, was a common practice in the industry. Both vendors and providers came under fire. Regulation may well be on the horizon.
But not everyone is waiting for the government to help level the playing field. Epic announced in 2014 it would no longer charge exchange fees. New accountable care initiatives are spurring change too. The Comprehensive Primary Care Initiative, a collaboration of almost 500 physician practices and insurers coordinated by the CMS, is exploring new ways to coordinate care. In Colorado, 74 practices providing care for 94,000 patients piloted a new online data tool, in which data and claims from both practices and payers across the state all link to a single web portal. This sort of interoperability will become essential for the risk stratification and care management that support pay-for-value reimbursement systems. Such initiatives show that interoperability is indeed possible. Furthermore, risk stratification of populations enables practices and payers to set-up reliable accountable care projects. The next step will be pushing that information from the cloud to individual practices.
While data blocking may offer short-term gains to competitors in a fragmented market, it won't prove successful much longer as healthcare moves toward integration. EHR vendors and customers planning on surviving in this industry will certainly strive to be interoperable. around will increasingly move towards interoperability.