This week the who’s who of health information technology is gathering in Chicago for the Healthcare Information and Management Systems Society (HIMSS) Conference. This conference generates a level of excitement among its target audience that is rivaled only by teenagers at a Taylor Swift concert. To put it mildly, these folks are excited. I will concede that they have lots of reasons to be excited. Information and digital health technologies are fundamentally transforming health care delivery and are starting to demonstrate some ability to improve quality and lower costs.
The progress we have made as a nation is commendable. A decade ago, President George W. Bush created the Office of the National Coordinator of Health Information Technology (ONCHIT) and called for the “widespread adoption of electronic health records in ten years.” This directive set our nation on a path towards the establishment and implementation of a HIT system. In 2009, Congress moved us further down that path when it enacted the Health Information Technology for Economic and Clinical Health Act (HITECH). This law established the meaningful use program and created an expectation that physicians and hospitals participating in the Medicare and Medicaid programs would use certified EMRs by 2017.
To date, federal and state governments have collectively paid more than $25 billion in incentive payments to hospitals, physicians and other health care providers. By most measures, one could easily argue that this investment and the meaningful use program has been successful. Today, almost 80 percent of family physicians use an EMR in their practice – many are frustrated by it, but they use it nonetheless. The percentage of hospitals using EMRs is even higher. Despite all this good news, there are some epic challenges that must be overcome if we are to realize the full potential of electronic medical records. The most notable challenge is the lack of interoperability and real-time data sharing between EMR products.
It is time for Congress and the Office of the National Coordinator for Health Information Technology (ONC) to reevaluate current regulations, with an emphasis on allowing EMR vendors to legally and systemically resist the transfer of patient data, in real time and free of administrative and financial obstacles, to patients, physicians, hospitals, and other health care settings. The current lack of interoperability not only hinders efficiency in care delivery, but also creates significant patient safety concerns. The inability to transfer patient information in real time means that physicians providing care to a patient may lack all the available information that would inform their decision making. Also, it is important to distinguish between the transmission of, for example, 80 pages of a medical record between two care settings versus the real-time transfer of patient data that is beneficial at the time of care. To fully realize the potential of EMRs, we need vendors to embrace the simple fact that patient data is not their data – it is the patient’s data and it should be readily available to the patient and their physicians. This is a major problem, and too few people are talking about it.
Through incentive payments, Congress created a guaranteed market for EMR vendors, and they have taken advantage of that opportunity. The problem is a guaranteed market is not necessarily a competitive market driven by innovation and competition. When you couple this lack of competition with the lack of portability in data, you create situation where physicians are essentially trapped with an EMR that does not adequately perform for their practice for years. This is known as “vendor lock.” You also create a situation whereby there is very little incentive for EMR vendors to modify their behavior or improve their overall performance. The reasons why EMR vendors resist interoperability is obvious: it protects their products from competition and allows them to maximize revenue since the costs that come with changing to a new EMR product are untenable for most physician practices. This is advantageous to their business model, but counter-productive to quality health care and our national HIT goals.
Last week in a report to Congress entitled “Health Information Blocking” the Office of the National Coordinator strongly criticized EMR vendors for current practices that limit the transfer of relevant patient data in a timely and efficient manner. The report states:
“The full extent of the information blocking problem is difficult to assess, primarily because health IT developers impose contractual restrictions that prohibit customers from reporting or even discussing costs, restrictions, and other relevant details. Still, from the evidence available, it is readily apparent that some providers and developers are engaging in information blocking. And for reasons discussed in our report, this behavior may become more prevalent as technology and the need to exchange electronic health information continue to evolve and mature.”
Kudos to the National Coordinator for issuing a report that draws attention to these issues, but we likely will need more than a public shaming to drive change. There is a simple and achievable solution. It is time for all EMR vendors that offer Certified Electronic Health Record Technology (CERT) to face significant and continuous penalties if they fail to make their products interoperable and if they engage in practices that limit portability of patient data with or between other CERT-recognized products. This not only would ensure that patients and their physicians have the health information they need to make timely and informed medical decisions, but it would establish some competition in the EMR market – which is clearly missing today.
Shawn Martin is the Vice President of Practice Advancement & Advocacy for the American Academy of Family Physicians.