Can vendors make health data interoperability a reality without government force?

It's only fitting that the new trailer for the next Star Wars movie was released just as the Empire--the EHR vendor community--strikes back in the battle for health data interoperability.

I'm teasing a bit here. The vendors aren't really evil. But after months of being accused of information blocking and raising other barriers to data exchange, the vendors now are taking steps to defend themselves in case the government decides to use its "force."

First, there's HIMSS' Electronic Health Records Association (EHRA) letter to the Office of the National Coordinator for Health IT, outlining its concerns with the agency's report to Congress on information blocking. The EHRA says, among other things, that:

  • The mere assessment of a fee for data sharing does not mean that it's cost-prohibitive and thus information blocking
  • Identifying what constitutes information blocking is challenging and very situation-specific
  • Non-standard and variations in connectivity options are not necessarily information blocking
  • There is a different between anecdotes and true information blocking
  • Not all information blocking is due to vendor or provider behavior; some it is regulatory, which results in unintentional or perceived data blocking

The EHRA urges the ONC to use caution and to not overreact and charge in--lightsabers a-blazing with new mandates--without knowing all of the facts. 

Instead, it asks for a "light touch" of guidance, and warns that the concepts of the report are not ready for inclusion in legislation.   

"[I]t is critical to remember that no one set of incentives or policy fixes [legal or regulatory] will serve to address the obstacles facing all stakeholders; it will take a combined approach of many factors to see comprehensive success," EHRA says.

The letter goes on to say that government intervention may be needed only where the private sector can't accomplish this on its own.

This dovetails well with this week's announcement that 12 major vendors have agreed to an interoperability measurement tool, which will be administered and publicly reported by Orem, Utah-based KLAS. The participants, which include providers and IT leaders, will "work closely" with the government, but make it clear that they want to be left alone.

Here it is: the chance for the private sector to attain interoperability.

"The power of the meeting was that the entire private sector agreed to public reporting of customer interoperability experiences without the need for regulation," John Halamka, CIO of Beth Israel Deaconess Medical Center, told FierceEMR.

Micky Tripathi, head of the Massachusetts eHealth Collaborative, echoed this sentiment. "We can self-regulate," he said. "We can do it. We're taking the initiative." 

Both Halamka and Tripathi, along with Boston Children's Hospital CIO Daniel Nigrin and Intermountain Healthcare Chief Medical Informatics Officer Stan Huff, were instrumental in designing the measurement tool the vendors agreed to use.  

The vendors clearly want to police themselves without government intervention.

I'm not against this, as long as it works. The EHRA brings up very salient points about not rushing in to legislate. And new consensus on how to measure and improve interoperability is a great development.

Having laws and regulations to get something accomplished when the private sector won't or can't is pretty common. Look at anti-discrimination laws, the mental health parity act, or even the HITECH Act, which spurred the adoption of EHRs.

But what if the private sector wants to do it and takes the right steps to do so?

We all know the risk that if a law is flawed, becomes outdated or just doesn't fit. It's difficult to correct course. That hits very close to home when it comes to interoperability. The Meaningful Use program has not done the best job there. The proposed 21st Century Cures Act, which also regulates interoperability, comes with its own set of problems.

The vendors have taken this route before, enacting a voluntary code of conduct to address gag clauses, improve patient safety and avoid data "lock out." But it was rife with loopholes and arguably ineffective.

So is this time the charm? Should they be left alone to achieve interoperability? - Marla (@MarlaHirsch and @FierceHealthIT)