Policymakers, vendors, providers share blame for interoperability headaches

There’s been plenty of finger-pointing over the lack of interoperability in healthcare, but one researcher says most of the blame lays on the shoulders of policymakers, with EHR vendors and providers sharing some of the responsibility.

Many are still wondering why healthcare hasn’t achieved interoperability and information sharing at the same pace as other industries, but the issue goes beyond just the technical barriers, Julia Adler-Milstein, Ph.D., associate professor for the school of information at the University of Michigan, writes in NEJM Catalyst. Transferring healthcare information also relies on cohesive business agreements, confidentiality standards and information governance, all of which require cooperation from multiple stakeholders.

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But Adler-Milstein argues that the initial decision by the Centers for Medicare & Medicaid Services and the Office of the National Coordinator of Health IT (ONC) to make health information exchange requirements part of Stage 2 Meaningful Use requirements allowed vendors to develop EHRs without considering how to integrate with HIEs that could facilitate data sharing. She adds that the HITECH Act wasn’t strong enough to incentivize vendors and providers to prioritize interoperability.

“Without strong incentives that would have created market demand for robust interoperability from the start, we now must retrofit interoperability, rather than having it be a core attribute of our health IT ecosystem,” she wrote. “And, if there had been stronger incentives from the start, we would not now need to address information blocking: the knowing and intentional interference with interoperability by vendors or providers.”

The ONC finalized its interoperability standards in December, shifting the resource to a web-based platform that will be more consistently updated. New HHS Secretary Tom Price has voiced support for improving interoperability in healthcare but has criticized MU requirements.

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Adler-Milstein also argued that EHR vendors unfairly shoulder most of the blame for the lack of interoperability, but she does note that instead of pointing out the flawed regulations, vendors often touted robust interoperability features even when they didn’t exist. Meanwhile, healthcare leaders should have put more pressure on vendors to incorporate interoperability from the start.