Legislators grill Karen DeSalvo on interoperability

The issue of poor interoperability between electronic health record systems took center stage at a Senate hearing Tuesday focusing on the promise of precision medicine.

National Coordinator for Health IT Karen DeSalvo was peppered with questions and comments from legislators about the current state of interoperability as it pertains to healthcare in general, President Barack Obama's Precision Medicine Initiative and with regard to the Department of Defense's pending EHR contract.

Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Committee on Health, Education, Labor & Pensions, pointed out that despite $28 billion spent on EHR adoption so far, physicians aren't keen on such systems due to, among other issues, disrupted workflow.

"It's a great idea; it holds great promise. But it's not working the way it's supposed to," Alexander said. "The current standards for Meaningful Use aren't clear. Upgrades are expensive. The systems don't work to share the data; we hear it's expensive to share the data because of some of the relationships between vendors and doctors."

To that end, Alexander asked DeSalvo if she would pledge to work with a newly formed working group focused on improving EHRs. DeSalvo said that she would work with the committee.

Alexander also pointed out that National Institutes of Health Director Francis Collins--who also testified at the hearing--called properly functioning EHRs "essential" for assembling genomes. DeSalvo noted that while EHRs are a great advancement, not all systems are part of the workflow in the way physicians want or expect in clinical practice.

"We are working toward a shared goal that [EHRs] will be an enabler," DeSalvo said.

Sen. Bill Cassidy (R-La.) later asked DeSalvo about the forthcoming DoD contract for a new agency EHR, specifically, if the new system would be interoperable with both the Department of Veterans Affairs' system, VistA, and with all other hospitals. He noted that two of the finalists for the contract--Epic and Cerner--were identified as companies that lack interoperability in a recent ONC report on information blocking.

"I feel like we're in a thicket here and we can't get out," Cassidy said. "We're about to spend $11 billion on a system that the VA's system is not interoperable with? Please tell me that I'm absolutely wrong."

DeSalvo responded by calling a move away from proprietary standards key to the process.

"Those vendors will have to agree to use the standards that the Department of Defense wants to use, which are the ones that ONC has published," DeSalvo said. "We are very pleased that we're moving in a direction to a have a core set of standards that everyone will agree to so we don't run into a problem where the systems won't talk to one another."

DeSalvo called the issue of interoperability between the DoD and the VA a separate issue "because the VA has separate technology," noting that the goal is focused on not just exchange of information, but total interoperability.

Cassidy then repeatedly pressed DeSalvo on the issue, saying that her answers "left some wiggle room," to which the National Coordinator responded that ONC recommended to DoD that the systems be able to talk to one another. She called the problem "solvable" from a technology standpoint, but noted that policy and cultural issues have proven more difficult hurdles.

"I've sometimes found that recommendations are not adopted," Cassidy said.

To learn more:
- watch the hearing

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