It's the doctors being enticed and goaded, not the EHR vendors

Computers connecting
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Marla Hirsch

Barely two weeks ago, I pondered whether the government’s ‘entice and goad’ approach in the Medicare Access and CHIP Reauthorization Act (MACRA) would spur electronic health record vendors into being better partners.  While vendors aren’t subject to MACRA, the law encourages vendors to help providers meet their goals by supporting them with better technology and more interoperability support.

It looks like we may already have our answer: no.

Vendors, it seems, are interfering with physicians’ ability to share EHR data with registries operatives by specialty societies, such as the American Academy of Dermatology and the American College of Cardiology, according to Politico. These registries have particular expertise in their respective specialties and collect information for research and clinical purposes. They also help physicians meet their reporting and interoperability requirements under MACRA.

Evidently, at least some of vendors won’t allow data to flow from physicians’ EHRs to the registries because the latter use third-party software that competes with the vendor’s tools. The vendors are delaying requests for the data exchange, charging or quoting exorbitant prices to integrate the software or outright refusing consent to transmit. Instead, they’re offering to sell the physicians their own versions of the software to send data to the registries, which isn’t cheap.

What's more, many doctors impacted are afraid to complain about the information blocking, even to the Office of the National Coordinator for Health IT, according to Politico. One vendor has threatened doctors with potential lawsuits if they don’t stop using such third-party software, according to the article. Such data blocking could adversely affect research conducted by the Food and Drug Administration and others.

ONC says it’s powerless to act.

What happened to the “pledge” earlier this year that vendors made to improve interoperability? What about the vendor code of conduct, where vendors would voluntarily work together to improve data exchange?

It seems that those don’t apply if vendors’ money is at stake. Evidently, the vendors see this as an opportunity to increase their market share by playing hardball and making it so difficult to use the third-party software that doctors have no choice but to buy the vendors’ version in order to report to the registries. 

The vendors are turning “entice and goad” on its head. Instead of being enticed and goaded to help doctors provide care and meet their goals, they’re enticing and goading doctors into capitulating to them. They’re using their clout to thwart data exchange unless the doctors are doing it in a way that profits the vendors.

And, according to Politico, the vendors aren’t denying it.

This shouldn’t surprise anyone. Why should vendors be expected to do something not in their best interests if they don’t’ have to?

MACRA’s entice and goad strategy to bring the vendors on board sounds good in theory. But it’s already not working in practice.

I hope the government has a plan B. - Marla (@MarlaHirsch and @FierceHealthIT)