Provider and vendor representatives discussed looming healthcare interoperability issues at Friday's meeting of the governance subgroup for the Health IT Policy Committee's Interoperability and Health Information Exchange Workgroup.
Interoperability, of course, is a primary focus for the Office of the National Coordinator for Health IT as it looks to transition out of the Meaningful Use era, although some health IT stakeholders worry about the agency's methods for achieving that goal.
Craig Behm--executive director of MedChi Network Services, a firm that offers practice services and accountable care organization management as a subsidiary of the Maryland State Medical Society--said he isn't sure that the barrier to connectivity is that physicians don't feel the urge to be fully interoperable. Not having broad standards for interoperability in place and allowing communities to figure out the details, Behm said, has led to providers chasing their tails.
"It seems like there are other technologic and business barriers that are really the problem," Behm said. "Until, for example, hospitals are not trying to narrow networks and build broader and more specific referral patterns, they're not going to have the same interoperability push that maybe certain accountable care organizations … might have. I think it's a broader issue and, unfortunately, we're not going to get very far in the next couple of years unless we look at the system as a whole rather than just individual pieces and incentives on individual players."
However, Amy Feaster, vice president of information technology for CenturaHealth, a 15-hospital system based in Englewood, Colorado, said incentives are a way to help progress such efforts. She also suggested single sign-on with health information exchanges from patient electronic health records as an alternative.
"In Colorado, at least, we don't have that yet," Feaster said. "Our physicians do want to look at data in the HIE, so they are not ordering duplicate tests, but they have to sign onto the HIE and search for the patient. If all the HIEs have to provide a single sign-on solution that interacts with the EHRs, that would be a big step right there."
Greg Wolverton, CIO of ARcare--a private nonprofit corporation that provides affordable primary care residents of rural Arkansas--said that from a practice perspective, interoperability is vital, agreeing with Feaster that incentives are key.
"The more interoperability or the more components we have related to interoperability, the less expensive we can deliver care," he said. "A good example of that, we've seen time and again, would be the nonrepetition of lab orders and being able to get that information. I think it is incumbent upon hospitals to improve, increase and include interoperability in the plans. What's wrong with incentivizing hospitals for something that does not have to be repeated?"
Carl Dvorak, president of Verona, Wisconsin-based EHR vendor Epic--which has been accused by federal legislators of operating a "closed platform" that hinders interoperability--said that at least one factor limiting health data exchange is HIEs forcing participants to pay full fees for individual services, such as access to public health and immunization registries. He said that states should provide such reporting as a free service "without requirements to pay for the use of a single monopolistic HIE in order to comply with Meaningful Use."
Dvorak also said that a national phone book of exchange-ready providers, simple and affordable trust validation service and straightforward "rules of the road" would help to improve interoperability and enable, within 12 to 18 calendar months, the development of an "ATM" for healthcare
"And that would include in that, supporting the eHealth exchange protocol as an unplanned transition of care protocol," Dvorak said. "We desperately need that at a national level, and our data shows that it is amazing in how well it works."
To learn more:
- here are the meeting materials