Monday morning interoperability quarterbacking: Better late than never

With the NFL's championship game a little more than a week away, there is much speculation about the Denver/Seattle match up--and there will be the inevitable Monday morning quarterbacking long after the game ends.  

Many people disparage Monday morning quarterbacking. It's always easier to review a decision after it's been tested and played out.

But sometimes, Monday morning quarterbacking serves a useful purpose, because it causes people to reassess a decision or judgment call. Even if it's too late to save yesterday's game, it may help tomorrow's.

That's what we're seeing with electronic health record interoperability. 

Back in the good old days of Meaningful Use Stage 1, providers merely needed to use an EHR and meet the clinical quality measures. The EHRs didn't need to talk to each other. Stakeholders and others began to worry that the lack of interoperability standards would hinder data exchange and patient care. Yet the government opted not to regulate interoperability, requiring it in later stages of the incentive program but deferring to market forces to create standards and make it happen. In hindsight this may not have been the best approach.

But at long last, people are reviewing how interoperability was treated.  

First, there's Congress considering requiring interoperability among EHRs in the Meaningful Use program as part of the physician payment SGR fix. Truly Monday morning quarterbacking at its finest. After all, it was Congress that created the HITECH Act and its Meaningful Use program. One has to question why interoperability wasn't stressed back then. Still, in 2009 the focus was different. At least Congress is looking at it now.

Then, there's the Office of the National Coordinator for Health IT trying to patch up interoperability. To be fair, ONC has been wrestling with interoperability for years and has been constrained by more pressing issues, such as EHR adoption itself. ONC has been supporting health information exchanges, and trying to figure out how to engage long-term care providers and others in data sharing.

Additionally, billionaire Patrick Soon-Shiong, MD, in a speech at the Clinton Foundation's 2014 Health Matters Conference last week, derided EHRs as  "medical bridges to nowhere" because they can't easily share data with each other. Soon-Shiong's new company, NantHealth, is his answer to the HITECH Act, providing an interoperability system that can talk to "any software."

Now that's market forces at work. although that may not have been quite what ONC intended. Instead of vendors collaborating to create standards, you've got an entrepreneur bypassing the current interoperability infrastructure.

This could make the health information exchanges obsolete.

Some warned years ago that EHRs were too variable to communicate with each other. So I'm sure that there are those that will say this new emphasis on interoperability is too late.

There's some truth to that. Time, resources and millions of dollars could have been saved if interoperability was more of a front burner item back before providers started purchasing EHRs.

But if the "system," as Soon-Shiong said, is flawed, it's better to fix it, at least partially, and move forward, than continue down the wrong path. After all, hindsight is 20-20. - Marla (@MarlaHirsch @FierceHealthIT)

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