At a Health IT Policy Committee governance subgroup meeting in mid-August, Carl Dvorak, president of Verona, Wisconsin-based EHR vendor Epic said that at least one factor limiting health data exchange is that many health information exchanges nationwide force participants to pay full and exorbitant fees for participation, even in the case of providers using individual services such as access to public health and immunization registries.
Morgan Honea (pictured), executive director for the Colorado Regional Health Information Organization--a nonprofit health information exchange that electronically connects providers throughout the state--who also testified at the meeting, took issue with what he saw as generalizations by Dvorak, calling them "unfair."
In part one of an exclusive interview with FierceEMR, Honea talks about Dvorak's claims, as well as his own thoughts on interoperability challenges. He also talks about the high cost of information technology implementation for providers.
FierceEMR: In your testimony at the meeting, you mentioned that one of the biggest hurdles to information exchange was the inability of many providers to upgrade their software. Please elaborate.
Morgan Honea: I think one of the challenges that we find ourselves here in Colorado is, we've been successful in a number of different efforts with healthcare reform. What that led to is one of the highest rates of Meaningful Use achievements in the U.S., one of the highest rates of EHR adoption in the U.S. To that end, when you get such massive uptake in new technology for an industry that has been slow in the technology sector, you start getting people all over the place.
One of the things we really have to manage is providers across the spectrum in terms of their readiness to not only meet Meaningful Use milestones, but also to meaningfully use their technology.
We've got over 80 percent of practices in the state using EHRs, and they're all over the map in terms of the current versions that they're on. CORHIO currently works with 28 different EHR vendors to connect practices to the HIE, and each of those is at different parts of the spectrum, as well. When you're managing such a huge network of providers to such a huge network of EHR vendors, it's a challenge to try to bring up additional services or connectivity for your network when you've got different providers and different vendors pushing different things into the network and varying capabilities of pulling things out of the network.
FEMR: Carl Dvorak's testimony seemed to hit a nerve with you, but you also talked about EHR vendors quoting large fees in your testimony. Do you think any one entity can shoulder all of the blame for lagging data exchange?
Honea: I certainly thought that it was an unfair generalization. I'm certain with both the number of EMR vendors in the market and the number of HIE vendors there's probably blame to be placed on both sides of the equation, though. I can tell you definitively at CORHIO, we are a nonprofit organization whose operating budget literally turns every dollar around to the improvement and expansion of our network and our services. That is a significantly different business model than you see in other portions of the health IT market.
I think that as you change different business models and you look at different value propositions for either vendors or HIEs, depending on what their mission is, that drives the differences in Mr. Dvorak's statement.
One of the thing maybe differentiates me in this position is that I used to be a practice administrator for a small rural healthcare provider, and the technology portion of our budget was very significant for the size of our operation. I know firsthand the challenge of paying for new technology that is necessary to maintain competition in the market today. It's certainly not a small undertaking and it's a cost that wasn't necessarily there 10 years ago.
As we continue to apply things like Meaningful Use, alternative payment methods, population health, expectations, improvements in transitions of care, the expectation is that systems can work together to coordinate information as they're coming in through different parts of the system. In Colorado, CORHIO has been a very good partner with Epic and the different hospitals and healthcare systems to make sure that that kind of data exchange capability is available. But at the end of the day, we're working for one mission, to improve the healthcare of Colordans and I thought it was a very unfair generalization for that statement to be made.
FEMR: Do you think there is a light at the end of the tunnel for providers as far as having to continue to spend big on information technology?
Honea: There certainly is a heavy lift associated with the implementation of systems. That cost kind of trails after the implementation process is over. I certainly think that we're in this time where we are kind of experiencing a heavy implementation cost structure. That should decline over time as we're more into the system management, but I think what you're also seeing in the market is, now that providers have been live on their EHRs for a handful of years, they're finding that some of their solutions haven't come along with them as healthcare reform is happening and the industry is changing. These same providers who have already borne the cost of implementing one solution are now going out into the market and having to adopt different tools because the ones that they selected five and eight years ago haven't evolved to the point that they need them to; they're bearing that implementation cost over again.
My point is that it seems to be a new item of the budget that is here to stay. In Colorado we've done a really good job of identifying how we can come together to leverage the different investments that are being made by the different systems in order to try to lift all boats, rather than lift one or two, and try to find as many economies of scale as possible. One of the faults of health information technology is the fact that, here we are in the process of trying to reduce costs in the system and we're adding this tremendous amount to individual facilities' budgets in a line item of health IT.
I think where we're headed is being able to empower those same systems to be able to get into the type of business models or contracting models that will allow them to reduce utilization, to better manage transitions of care and to better manage patient outcomes. Hopefully as we see this new emergence of health IT costs within the system, we'll see support decreases in cost in other areas, whether it's utilization or management of patients.
Unfortunately, what we also see is this churning of adoption of different solutions that continue to impede people's ability to get costs under control.
Editor's Note: This interview has been condensed for clarity and content.