When the federal government (CMS) released the final rules for both meaningful use Stage 2 modifications and Stage 3 earlier this month, and at the same time, the final version the Office of the National Coordinator of Health IT (ONC) Roadmap, there were a few loud messages that it was clearly trying to convey: the need for a “person-centered” healthcare and a commitment to interoperability.
For those who have been following the words and actions of senior-level leadership at ONC and CMS throughout the last year, this should come as no surprise. At this year’s Healthcare Information and Management Systems Society (HIMSS) conference in Chicago, in her annual meeting with the press, Karen DeSalvo, M.D., National Coordinator for Health IT, said that its time to advance ideas beyond electronic health records (EHRs), with the push towards a more interoperable healthcare. "The EHR is one of major drivers to advance care, but the world has evolved and advanced, and now the ecosystem is much broader than EHRs. To provide person-centered care, you need a model that's beyond episodic visits, and we need to make certain that we're allowing technology to evolve. EHRs only tell one part of story," DeSalvo said at HIMSS15. Indeed, with the release of the MU rules, CMS released a statement that similarly said, “By 2018, these rules move us beyond the staged approach of ‘meaningful use’ and focus on broader delivery system reform.”
Additionally, in its final Interoperability Roadmap, ONC outlined three-, six- and 10-year goals for the flow of data between consumers and providers and between different segments of the nation's healthcare system. According to HCI Assistant Editor Heather Landi’s report on the Roadmap, by the end of 2017, the ONC intends for the majority of health providers and consumers to be able to send, receive, find and use a common set of clinical information in order to improve healthcare quality and outcomes. In six years, by the end of 2020, ONC intends to expand data sources and users in the interoperable health IT ecosystem to improve health and lower costs. The ultimate goal, to be achieved by 2024, is nationwide interoperability that enables a learning health system, “with the person at the center of a system that can continuously improve care, public health and science through real-time data access.”
Nonetheless, while the vocal words and written rules from the feds are as clear as day, industry stakeholders are still wondering if enough is being done to truly advance interoperability. Regarding the meaningful use program, some say if anything, it’s a barrier to interoperability. Leslie Kriegstein, interim vice president of public policy, at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), recently told me, “We want a complete overhaul of the program, focusing on interoperability and security. CIOs have pointed to that for a while. What are other ways we can show that we are meaningfully using health IT that isn’t the ‘checking the box’ mentality of meaningful use? How else can we tangibly show outcomes?”
Then there is of course the push from the Hill, namely Sen. Lamar Alexander (R-TN), who has repeatedly shown his distaste for the EHR incentive program, most recently citing a Government Accountability Office report which, after interviewing leaders from various health information exchange (HIE) initiatives, concluded that changes to the meaningful use program would be needed to better promote interoperability. Specifically, the report noted that efforts to meet the programs’ requirements divert resources and attention from other efforts to enable interoperability. For example, initiative representatives explained that the EHR programs’ criteria require EHR vendors to incorporate messaging capabilities into EHR systems, but this capability generally does not enable interoperability at this time.
What’s more, an American Hospital Association (AHA) report recently cited how the lack of interoperability in healthcare is especially troublesome given the amount of dollars the nation has spent on health IT. Similarly, the American Academy of Family Physicians (AAFP) recently wrote a letter to ONC citing “inadequate” technology. AAFP Board Chair Robert Wergin, M.D, called for “more than a roadmap. We need action,” he said.
Indeed, it feels like the industry is at a crossroads: on one hand, federal leaders have talked the talk plenty about wanting interoperability in healthcare like we see in other sectors, such as transportation, telephones, and banking, but on the other hand, it would be fair to ask if they are truly doing everything in their power to make this happen. Are their plans specific enough or too broad? Adding to this, it would also be fair to ask if vendors and providers are doing enough themselves to help the cause.
I recently spoke with Arien Malec, vice president of data platform and acquisition tools for RelayHealth (the Alpharetta, Ga.-based McKesson business unit that focuses on improving clinical connectivity) and former ONC staffer about this very issue. He told me that the “right role of government is to set a clear destination, put in place the right levers, particularly in terms of payment policy, not micromanage, and not define the ‘how’ too much.”
Malec further urged that providers and vendors stop complaining and take action. “I have a general perspective; I don’t make a distinction between leading and following, I make a distinction between leading and accepting the world as it is. If you’re not leading, you’re accepting the world as it is, and if that’s the case, you can’t sit back and complain about it. Start getting involved in trying to improve the world if you don’t like how it exists. That’s the number one best practice.”
He continued by saying that vendor organizations could join the Argonaut Project, join CommonWell, implement SMART on FHIR, or if not, “do something to improve the state of interoperability.” If you’re a provider organization, he said, there are the same kinds of initiatives to participate in. A number of providers are participating in Argonaut offering to be demonstration sites and get technology up and running, he noted.
It was refreshing to hear Malec’s take when many people who you talk to (as seen above) prefer to point fingers at those who might be causing the problem. We all can be guilty of that at times—frankly, sometimes it feels easier to complain than to improve.
There is another issue at hand here, and that is the concept of perception. Perception is a funny thing; sometimes with enough momentum, perception can be stronger than reality. There is a perception in the healthcare world that Epic Systems, the Verona, Wisc.-based health IT giant, is a vendor that struggles with interoperability and won’t open its systems. However, a recent KLAS report on interoperability found that while 44 percent of providers with no or very limited Epic experience report this perception that Epic struggles with interoperability, actual customers of the vendor, providers connecting into Epic, and even other vendors give Epic high marks for interoperability strengths.
Another perception is that information blocking is a big barrier to interoperability, per an ONC report in April. But according to Malec, in terms of EHR vendors refusing to open up interfaces, this doesn’t happen anywhere. To this point, Daniel Barchi, senior vice president and CIO of Yale New Haven Health System & the Yale School of Medicine, recently wrote in a contributed piece for HCI that, “There is little evidence that hospitals or physicians are hoarding patient data for their own gain. Quite the opposite is true—after years of building and implementing EMRs, health providers have turned their focus to better data sharing with patients and other providers.”
At the end of the day, there are four big groups right in the thick of this interoperability discussion—the vendors, the providers, the government, and the patients. It’s that last group that should be motivation enough for the other three groups to take action. We all want a person-centered healthcare, as DeSalvo and the government have said all along, right? Well, as an industry then, let’s do what Malec says—“Roll up your sleeves and get involved somehow.”
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