Tackling Interoperability

Two industry groups address the problems of health care’s complicated connectivity

One of the most frustrating things patients deal with when interacting with the health system is attempting to share medical information among new specialists or facilities. From filling out the same form multiple times to potentially life-threatening delays in treatment due to crossed wires on prescriptions or referrals, patients may not know interoperability by name. But they certainly know its impact.

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Interoperability is growing, but still incomplete

All three studies, based on data collected by independent surveys, were written by researchers from the Office of the National Coordinator for Health Information Technology at HHS.In a study of the electronic means and methods used for patient engagement, the number of hospitals that allow patients to view, download or transmit their own medical records has vastly increased, according to data from the American Hospital Association survey.

By far the most widespread function is the ability to electronically view patient records, chiefly through portals.

In 2014, 91% of hospitals offered that capability, up from 24% in 2012.

Transmitting a record from a hospital’s EHR to another provider’s EHR or a patient’s device was the least available function, with two out of three hospitals having that technology

A VDT requirement in the federal EHR incentive payment program’s Stage 2 meaningful-use criteria was one of its most controversial. It was reduced from 5% of a providers’ patients to one single patient in the recently released final rule.

But hospitals also have adopted a plethora of other computer-assisted patient engagement technologies, including allowing patients to amend their records, request prescription refills, schedule appointments and submit patient-generated data. All of these functions increased by nearly 100% or greater since 2012.

Office-based physicians (PDF) are increasingly embracing interoperability as well, according to a separate study based on data for 2013 and 2014 from the Center for Disease Control and Prevention’s National Electronic Health Record Survey. For example, more than half of physicians exchanged secure messages with patients in 2014, up from 40% the prior year, while 42% exchanged patient information with another healthcare provider in 2014, compared with 39% the prior year.

Types of information exchanged in 2014 were fairly uniform, with 34% sharing lab results and medication lists, 33% exchanging medication allergy lists and problem lists, and 32% exchanging imaging reports. But fewer than one in 10 physicians exchanged all five types of information, the study reports.

Finally, patients (PDF) are slightly less engaged in information sharing, but they are warming up to interoperability too, according to the third report, based on data from consumer surveys by the NORC, a research arm of the University of Chicago, and the MITRE Corp., a research and think tank.

In 2014, 38% of survey respondents indicated they had been offered access to their online medical records, but that was up from 28% the year before. And of those offered access, more than half viewed their records at least once in 2014, up from 46% in 2013. In both 2013 and 2014, about 7 in 10 individuals who accessed their online medical record, used it to monitor their health.

Lab test results were the most commonly viewed record, by 92% of patients, followed by a list of their medical problems and current medications. Eighty-one percent of consumers reported in 2014 that they found the information useful, down slightly from 81% the prior year.

“Access to individual health information online is only a starting point,” ONC chief Dr. Karen DeSalvo said in a blog post preceding the release of the surveys. “As a community, we have more work to do to ensure that individuals and their families can fully digest and understand their health information.”

Feds say we can achieve full interoperability in 10 years. Most providers say: Yeah, right.

Goal is outlined in ONC’s roadmap

Fewer than 20% of health care providers believe the Office of the National Coordinator for Health IT (ONC) can achieve nationwide interoperability in 10 years, according to a survey by document management company Scrypt.

The findings were part of poll of more than 700 providers on their opinions of interoperability and HIPAA guidelines.

Background on ONC’s goal

Earlier this year, ONC unveiled a draft roadmap to achieve basic electronic health data interoperability by 2017.

It outlines short- and long-term goals for the next 10 years, with 2017 set as the deadline by which “a majority of individuals and providers across the care continuum” should be able “to send, receive, find and use a common set of electronic clinical information.”

In addition, the document outlines 10 updated guiding principles for achieving nationwide interoperability over a 10-year period based on stakeholder feedback.

Survey findings

However, the new survey suggests that just 17% of providers are confident the health care industry will meet ONC’s 10-year interoperability goal.

Meanwhile, the survey also found that while 98% of respondents said their organizations have policies in place to keep staff updated about HIPAA compliance changes in their practice, staff or human error remains the largest concern among providers in terms of HIPAA breaches (Monegain, Healthcare IT News, 8/11; Slabodkin, Health Data Management, 8/12; Scrypt release, 8/11).

Via The Advisory Board »

Health Data Interoperability Needs Information Blocking to End

From federal government agencies and the medical industry to patient advocate groups and vendor-neutral companies, the push for greater health data interoperability with the healthcare market remains strong. As seen in the proposed rule for Stage 3 Meaningful Use Requirements, the Centers for Medicare & Medicaid Services (CMS) along with the Office of the National Coordinator for Health IT (ONC) continue to stress the importance of health data interoperability.

ONC explains on its website that EHR systems will only reach their full promise when they effectively exchange medical data throughout the healthcare continuum. Health data interoperability through health IT systems and certified EHR technology will improve physician workflows and enable better health information exchange.

There are certain health IT interoperability standards that are necessary for improving data exchange and these cover how users interact with a system, the messaging capabilities of differing platforms between each other, the management of health data exchange, and the integration of consumer tools with relevant medical systems.

While the federal government knows the importance of health data interoperability and continues to stress its importance, there may be certain entities including healthcare providers and EHR vendors that have played a role in blocking information flow throughout the healthcare industry.

Entities within the medical sector have charged large interface fees when data access requests were made and Congress is now attempting to put an end to information blocking through these means.

“Providers are fed up with interface fees and at how hard it is to accomplish the workflow required by Accountable Care business models including care management and population health. They are unsatisfied with the kind of summaries we’re exchanging today which are often lengthy, missing clinical narrative and hard to incorporate/reconcile with existing records,” stated John D. Halamka, MD, MS, Chief Information Officer of Beth Israel Deaconess Medical Center, in his latest blog post.

Halamka lays out a few key solutions for the problems surrounding health data interoperability and the ongoing issues of information blocking. First, it is important to define the necessities of care coordination and care management. Additionally, Halamka insisted that it’s time to put an end to the meaningful use requirements under the EHR Incentive Programs, explaining that they are no longer necessary.

A few other steps necessary for improving health data interoperability, according to Halamka, are: (1) creating a national provider directory in order to route messages, (2) developing a voluntary national identifier in healthcare, and (3) guiding state privacy laws to break down information blocking.

The American Medical Informatics Association (AMIA) also recently provided recommendations for improving health data interoperability within health IT systems. The organization emphasized the need for EHR certification standards that offer more technical requirements for boosting EHR interoperability and secure medical information exchange.

Additionally, more healthcare providers would benefit from developing a comprehensive healthcare IT roadmap. The latest results from Frost & Sullivan show that approximately half of medical providers worldwide do not have an IT roadmap stressing EHR interoperability. By following the steps set forth among these medical groups, researchers, and experts, the healthcare industry may be able to significantly improve health data interoperability over the next several years.

Via EHR Intelligence

Redirecting ONC’s interoperability roadmap

The draft interoperability roadmap released by the Office of the National Coordinator for Health IT contains so many details in its 166-pages that has been called “meaningful use on steroids.”

The roadmap draft appeared in late January to coincide with the ONC National Meeting, which focused largely on interoperability. The document’s language indicates that agency officials appear set to get the healthcare industry to once again place a high priority on becoming interoperable, says Dan Golder, principal of Naperville, Ill.-based Impact Advisers.

“The roadmap is meaningful use on steroids,” he said. “There is quite a bit in there, but every page has a lot in it that is worthwhile. It is still a draft, so it is influenced by comments. It will be interesting to see how that plays in the next couple of months.”

“The roadmap is meaningful use on steroids,” he said. “There is quite a bit in there, but every page has a lot in it that is worthwhile. It is still a draft, so it is influenced by comments. It will be interesting to see how that plays in the next couple of months.”

Golder senses a shift in tone away from the meaningful use that has preoccupied healthcare organizations and putting emphasis back on interoperability.

“I look at this and say ONC cut its teeth on meaningful use and this is the next logical step forward,” he said. “I’m interested to see how these two tie together.”

To be sure, healthcare is entering “a very interesting era,” adds Harry Greenspun, MD, director of the Deloitte Center for Health Solutions in New York.

“It has moved along from the era of EHR adoptions to the era of impatience,” he said. “Tremendous investment has been made in IT systems, EHRs and medical devices. They’ve got the data flowing, but with consolidation of provider organizations, they need a clean installation of IT across these newly formed systems.

“It brings up questions about how to advance interoperability – health information exchanges, EHR vendors, or a private platform?” he added. “It’s an era where everyone is getting impatient.”

Greenspun says he finds it “curious” that the ONC roadmap focuses exclusively on EHRs and not on medical devices.

“We’re seeing provider-led organizations saying this is costing us money and is a patient safety issue,” he said. “Some believe the industry has gone too slow and that providers need to leverage their collective buying power to force the issue. It is coming to a head because EHRs are in place and they don’t want to live in a world where plastic is substituted for paper.”

IHE is ‘critical’
The IHE North American Connectathon is where interoperability gets an annual test of progress, functionality and success every January. After 16 years in Chicago, the event moved to the new co-facilities of the Cleveland Convention Center and Global Center for Health Innovation, home of the HIMSS Innovation Center.

Besides serving as one of the public sector participants, the ONC cited the IHE Connectathon and IHE Profiles as “critical components to enable interoperability” in both the draft Interoperability roadmap on Jan. 28 and the 2015 Interoperability Standards Advisory on Jan. 30.

This year’s event featured 98 participating organizations, 148 tested health IT systems and 555 on-site participants with 19 percent international attendance. In collaboration with the Connectathon, 78 vendors will be demonstrating more than 100 health IT systems at the HIMSS15 Interoperability Showcase in Chicago in April.

“IHE is known for its technical specifications that form the foundation of interoperability and data exchange, its broad industry expertise and its experience in system-to-system testing and certification,” said Joyce Sensmeier, president of IHE USA. “What the world is discovering is IHE’s value as a leader in advancing standards-based interoperability in the marketplace.”

Population principles
Phillip Burgher, director of software development, data platforms and PQRS at Alpharetta, Ga.-based Wellcentive considers the ONC documents to be “very well written and concise statements of the problems we face in the industry.” Vendors, he said, “now have something to lean on for standards we want to use.”

The ONC guidelines address best practices, but don’t address the business model for interoperability, he said. That is where a third piece, the recent HHS announcement on value-based reimbursement, fills in the void. “You must have a purpose – interoperability for interoperability’s sake won’t work,” Burgher said. “If you connect the dots, you do it with analytics and population health and measure how you want to do it. Interoperability is how you do population health.”

The conversation, he says, needs to be extended from the patient and provider levels to the population level.

“Interoperability is very EHR centric – but EHRs are not the only source of data you need for population health – you need to tie in the whole ecosystem,” he said. “It is not a technology issue, it’s a business issue.”

The HIE factor
Just as interoperability needs renewed interest from healthcare providers, so do health information exchanges, says Scott Whyte, senior vice president of growth and innovation for Tempe, Ariz.-based Cleardata.

“Hospitals want to have good relations with physicians, who sometimes feel separated,” he said. “The HIE helps keep them connected. Primary care physicians keep apprised of EMRs and that aligns with accountable care and demonstrates they are providing good outcomes.”

Before joining Cleardata, Whyte helped build one of the largest private HIEs in the country at San Francisco-based Dignity Health. The network includes 8,500 physicians and extends over three states as a platform for population health and accountable care.

The key to growing a strong HIE, Whyte says, is agility, security and scalability. But while they have made strides in advocacy, generating outcomes and fostering understanding of population health, HIEs still have obstacles to overcome.

“There are gaps – the biggest are upstream,” he said. “If measuring improved health is what we want to do, we need to look at delivery and the problems with EMRs, content management and outcomes. The whole issue of interoperability plays into that very much.”

Engaging LTC
Long entrenched at the lowest rung of the healthcare provider ladder, long-term care and post-acute care providers are getting new opportunities in the value-based healthcare business model as part of emerging accountable care organizations. It is a space that greatly interests Salt Lake City, Utah-based VorroHealth.

“We are shifting to the LTPAC space – over the next two or three years it will really start moving,” says Billy Waldrop, vice president of operations. “Our company is focused on engaging, pairing, and connecting with long-term care interoperability. The aging population is bringing in more people to that space. We are bringing technology to the table – applying a methodology to get things done without being overly complex. The long-term care space is wide open.”

Still not talking: Health IT interoperability remains elusive

Interoperability of electronic health records remains a bridge too far for many providers, despite more than a decade of federal emphasis on information exchange and $29.1 billion spent on federal EHR incentive payments that were ostensibly tied to meaningful-use requirements mandating interoperable computer systems.Only 11% of respondents to this year’s 25th annual Modern Healthcare Survey of Executive Opinions on Key Health Information Technology Issues said their organizations were able to routinely exchange electronic patient information with other providers across the country.That meager showing comes 11 years after President George W. Bush created the Office of the National Coordinator for Health In-formation Technology with a mandate to implement a “nationwide interoperable health information technology infrastructure.”Interoperability is shaping up to be a key feature of this week’s Health Information and Management Systems Society convention in Chicago, where Bush is booked as a keynote speaker on Wednesday. ONC chief Dr. Karen DeSalvo will press the government’s case for interoperability in her keynote speech Thursday.
The show’s 12th annual “Interoperability Showcase” should be a main attraction. Yet only 17% of respondents to this year’s survey indicated their hospitals and physician offices can move patient records around their home states. Just 21% reported they can exchange records within their regions. In contrast, 21% of respondents said they aren’t exchanging electronic information at all, either within or outside of their organizations. Still, an overwhelming majority of respondents (71%) were optimistic they’ll be able to exchange a “core data set” of patient information nationally by the end of 2017 in keeping with a goal set in the ONC’s “interoperability road map” released this January. And 72% of those taking our survey opined that achieving nationwide interoperability would be of either high value (23%) or moderate value (49%) to their organizations. The road map signaled a shift in emphasis by federal health IT policymakers away from EHR adoption and toward health information exchange.
The government now expects the huge taxpayer investment in computer technology to improve healthcare quality and safety, and lower costs.But 28% of providers question the benefits of nationwide information exchange. Physicians at Chicago’s Northwestern Memorial HealthCare, for instance, can exchange patient information nationally using an interoperability module in their EHR software developed by Epic Systems Corp., said Dr. Lyle Berkowitz, Northwestern’s associate chief medical officer of innovation.The module, called Care Everywhere, can connect the developer’s customers and anyone else that uses industry standards. Berkowitz also expressed confidence that Northwestern would meet the ONC’s 2017 interoperability goal, which is limited in its data set.He placed “low value” on nationwide interoperability. Berkowitz said that as a primary-care physician, “nationwide exchange is not particularly needed.”“Local exchange is helpful, however,” he said, for example, if a patient from one organization appears in the emergency room of another. “For our specialists, however, the nationwide exchange might make sense.”
But Steve Long, CEO of Hancock Regional Hospital, Greenville, Ind., sees the need for the broadest level of interoperability, giving it “high value” on the survey. “As I look to the future of healthcare, it’s all about population health,” he said. “In order to really manage a population, we need to have complete interoperability. If we don’t have that with our tertiary partners, post-acute-care providers, (for) population management all up and down the continuum of care, we won’t get there.” While the federal government a year ago postponed implementation of the ICD-10 diagnosis and procedural coding system until October, survey respondents do not believe another postponement is in the offing. Preparing for the switch topped this year’s list of survey “hot button” priorities.
At 25-bed Ray County Memorial Hospital in Richmond, Mo., ICD-10 readiness was certainly one of Chief Financial Officer Donald Harr’s hot-button priorities. Harr was among the 42% of survey respondents who were “somewhat confident” they’ll be ICD-10 compliant by deadline.“We have a certified trainer on ICD-10 that gives us an edge,” Harr said. “She’s gone to all the departments twice and she has to go back to all of them again” before Oct. 1. Harr was among the plurality (48%) not in favor of delaying or scrapping ICD-10. “It’s going to happen,” Harr said. “I’d just like to get it over with.”Perhaps more of a surprise was the second-place ranking among hot-button issues for the adoption or upgrading of financial, clinical and analytic systems to handle the demands of accountable care organizations and patient-centered medical homes.
“We’ve done a lot of work on population health management with very little health IT infrastructure,” said Dr. Farhan Fadoo, chief medical information officer at San Joaquin General Hospital in French Camp, Calif. In 2011, the 196-bed safety net hospital began using a specialty software system for population health, i2iTracks, with “largely a paper-based workflow.” “There was a lot of manual entry, but it’s paid big dividends in getting us ready for risk-based contracting,” Fadoo said. Now, as the hospital prepares to buy and install a comprehensive EHR, a goal is to ensure no population health-management capabilities are lost in the transition, he said.

ONC targets interoperability, privacy in proposed rule

Electronic health-record interoperability is at the heart of the Office of the National Coordinator for Health Information Technology’s half of a two-pronged federal rule-making effort announced Friday.

The new rule covers the next phase of the government’s $28 billion EHR incentive payment program. The ONC portion deals with the technical aspects that EHR developers must meet for their systems to quality for use in the program. A tandem rule for Stage 3 meaningful use also was released Friday by the CMS covering providers’ use of the technology.

The ONC portion takes dead aim on achieving interoperability, a goal set by Congress in 2009 that has been on the back burner as regulators initially focused on promoting EHR adoption.

The proposed new rule “identifies how health IT certification can support the establishment of an interoperable nationwide health information infrastructure” and also lists nine priorities.

Topping the list is a proposal to adopt “new and updated vocabulary and content standards for the structured recording and exchange of health information, including a Common Clinical Data Set composed primarily of data expressed using adopted standards.”

It also specifies use of the Consolidated Clinical Document Architecture, or C-CDA, an exchange standard developed by Health Level 7, a not-for-profit healthcare standards development organization.

The rule also listed as a top priority facilitating the exchange of healthcare data through “application programming interface capabilities,” which would make the use of APIs a testing and certification requirement. APIs are essentially software intermediaries that allow different devices and systems to understand each other and to share data.

The shift in emphasis to interoperability was foreshadowed in January when the ONC issued a 10-year “Interoperability Roadmap” that, among other things, set as a target the selection, adoption and widespread use and exchange of a common set of electronic clinical information at the nationwide level by the end of 2017.

Using federal persuasion to move the healthcare industry toward the widespread use of APIs was a key recommendation in a 2014 report by a panel of scientist/advisors known as the JASON, which looked at interoperability problems confronting the healthcare industry under contract with the Agency for Healthcare Research and Quality.

A modified version of the JASON recommendations are being explored by a consortium of several large healthcare providers and major health IT developers known as the Argonaut initiative.

Another priority in the new rule is the required adoption of technology known as data segment for privacy, or DS4P, which uses so-called metadata tagging to earmark certain data for special handling in compliance with federal and state privacy laws.

One particularly stringent healthcare privacy law, known as 42 CFR Part 2, requires that providers obtain the consent of patients in federally funded drug and alcohol treatment programs each time their medical records are disclosed to another healthcare organization, even for treatment, payment or other healthcare operations. DS4P technology enables the attachment of those consents—or constraints—to patient’s electronic records.

The ONC noted DS4P technology has moved from the drawing board into use by providers, pointing out that a Florida organization with DS4P technology “has saved some hospitals millions of dollars associated with the cost of care.” That’s because “the patients they treat with substance abuse or behavioral health issues were able to send an electronic referral and get a discharge performed earlier in the process,” the rule makers wrote.

Last year, a federal advisory panel recommended taking only “baby steps” toward requiring the use of DS4P technology in the EHR incentive payment program.

ONC rule makers said they are proposing only an “initial step.” They’re requiring qualifying developers to create EHRs that can apply privacy tags only to entire documents containing sensitive information, and that these documents can be sent and received with the tags.

The ONC will not require vendors to develop systems that can tag discreet data elements within a record, such as a specific, sensitive prescription or lab test result, even though that’s technically possible to do.

The 431-page ONC rule is slated for official publication in the Federal Register March 30, which will trigger a 60-day public comment period. A final rule is expected to be issued this year.

Software in compliance with provisions of the 2015 Edition criteria won’t be required for use by providers in the EHR incentive payment program until 2018, but, theoretically, the systems could be adopted as early as next year if vendors perform the upgrades and have their systems tested and certified to the new standards before then.

Via ModernHealthcare.com »

Vendors’ fees are blocking interoperability, physicians say

“My vendor holds my data hostage, and I have to pay a ransom to access it,” said a primary care physician from Oregon in a Politico report.

This is the largely shared sentiment by many professionals in the healthcare industry who are pushing for interoperability but face financial barriers from IT vendors. As the federal government continues to push for digitized records, interoperability and shared data, physicians are finding the EHR records stuck and siloed by individual vendors who charge them to share data. Physicians pay anywhere between $5,000 and $50,000 to set up the infrastructure to allow for data sharing, either transmitting information to laboratories or connecting to HIEs, according to the report.

“The No. 1 factor hindering the exchange of information between healthcare stakeholders is the exorbitant fees that most EHRs are charging for integration, connectivity and reporting,” said Lance Donkerbrook, COO of Tempe, Ariz.-based Commonwealth Primary Care ACO in the report.

According to the report, vendors argue they don’t have any customer demand to participate in interoperability, to which physicians largely disagree, many of which are required to be interoperable to meet meaningful use requirements.

It seems vendors will be unlikely to address interoperability because it makes little business case for them to address it. To illustrate, EHR provider NextGen Healthcare’s sales revenue fell from $149 million in 2012 to $87 million in 2014. However, its data interchange fees increased during that same time period from $49 million to $67 million, according to the report.

To combat the vendor pricing, Rep. Michael Burgess (R-Texas), MD, who leads the House Energy and Commerce trade subcommittee, is drafting a bill to require interoperability. “It’s unfair that practitioners have to spend money on connections they thought were part of the EHR when they bought it,” he said in the report.

Rep. Burgess told Politico that he believes this issue will be resolved in the marketplace, but legislators are examining what legislation might look like if it isn’t ultimately resolved.

Via Becker’s Health IT & CIO Review

Doctors say data fees are blocking health reform

As they move to exchange patient information with hospitals and other health care partners, doctors are suffering sticker shock: The vendors of the health care software want thousands of dollars to unlock the data so they can be shared.

It may take an act of Congress to provide relief.

The fees are thwarting the goals of the $30 billion federal push to get doctors and hospitals to digitize health records. The exorbitant prices to transmit and receive data, providers and IT specialists say, can amount to billions a year. And the electronic health record industry is increasingly reliant on this revenue.

The goal of the 2009 program wasn’t just to move doctors from paper chart to computer. It was also to share the information, improve the quality of patient care and ultimately bring down U.S. health care costs.

Most doctors and hospitals have now switched to electronic health records, or EHRs. But the information is often stuck in computers run by hundreds of competing health care software companies — with incompatible products and scant incentive to make them compatible, or “interoperable,” as the industry calls it.

The additional costs were not foreseen during the bipartisan congressional push to create the federal incentive program. The expense is now imperiling the broad efforts to reform health care and adding to the host of technical obstacles that already hamper the flow of information.

“I believe this to be the biggest threat to the investment the nation has made in health IT,” said David Kendrick, head of Oklahoma’s health information exchange, which links doctors, hospitals and labs in his state. “All the money spent on electronic health records has yielded only a fraction of the value of getting interoperability.”

“It’s like giving everyone cellphones and not putting up a cell tower,” he added.

GOP congressional leaders are usually reluctant to intrude on business practices. But in this case, some GOP lawmakers are considering sanctions on the software vendors.

“Interoperability is what makes an EHR useful,” said Rep. Michael Burgess (R-Texas), a physician who leads the House Energy and Commerce trade subcommittee and is drawing up a bill to enforce data sharing. “It’s unfair that practitioners have to spend money on connections they thought were part of the EHR when they bought it.”

And it’s frustrating to physicians trying to tap into the promise of real-time electronic patient information. “My vendor holds my data hostage, and I have to pay a ransom to access it,” said an Oregon primary care doctor.

The potential of shared data to improve the quality of care while containing costs was one big reason the federal government paid doctors to get electronic health records. Getting that information in real time lets doctors keep tabs on their sickest patients.

That Oregon doctor, for example, could learn immediately when a diabetic patient entered an ER with a foot infection, rather than finding out a week later — when it was too late to make sure he got out of the hospital fast with the right medications to take home.

When data sharing works, it has good results. “The minute any one of my patients is seen at a hospital or gets an X-ray, the result goes immediately to my electronic health record,” said Ed Bujold, a western North Carolina family doctor.

An affiliated hospital system waived a $10,000 fee to set up Bujold’s electronic pipeline. But in general, doctors pay $5,000 to $50,000 each for the privilege of setting up connections allowing them to transmit information regularly to blood and pathology laboratories, health information exchanges or governments, according to more than a dozen sources interviewed for this story. Sometimes additional fees are charged each time a doctor sends or receives data.

“The No. 1 factor hindering the exchange of information between health care stakeholders is the exorbitant fees that most EHRs are charging for integration, connectivity and reporting,” said Lance Donkerbrook, chief operating officer of Commonwealth Primary Care ACO, an affiliation of 250 independent physicians. They can’t share information because they have 30 different EHRs among them, and each vendor wants $7,500 to $40,000 to connect them, he said.

“The government needs to step in immediately and require these vendors to open access,” he said.

The Electronic Health Records Association, which represents most vendors, would not comment on companies’ pricing policies. But it said the connections were expensive because of the lack of common computer-code standards across the hundreds of EHR manufacturers.

“As with other areas of health care, variability increases costs, and all stakeholders in health care need to work together to reduce this variability and the factors that drive it,” said Sarah Corley, the association’s vice chairwoman and chief medical officer of NextGen Healthcare.

Some question EHR makers’ commitment to easier access. New York and 18 other states spent five years creating simple standards for EHRs to link to health information exchanges in order to eliminate the need to connect with individual EHRs through individual interfaces — “each one a handcrafted engineering problem that costs thousands of dollars and takes weeks if not months of engineering to connect,” said David Whitlinger, executive director of the New York eHealth Collaborative.

Vendors took part in creating the standards, but when it came time for them to certify their products, they declined to participate, Whitlinger said.

“They all said, ‘We don’t have any customer demand for those,’” he said. “We said, ‘We beg to differ.’ No one came right out and said it, but if you look at the [EHR companies’] financials, you see they are making lots of money from building their own interfaces.”

Farzad Mostashari, an architect of the incentive program who now runs a business helping set up alliances to improve care quality, angrily raised the issue of high fees this month at a meeting of the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC), which he led from 2011 to 2013.

The practices that he advises want to share data but “can’t get their own data out,” Mostashari said. They pay $10,000 to be able to transmit clinical care documents, “not because of technical standards, but because of business practices. The vendors don’t have the same incentives as the providers do.”

Mostashari’s successor at the ONC, Karen DeSalvo, acknowledged the problem in response to a similar complaint at a conference the next day. His was a “common refrain,” she said, that “Congress has asked us to do something about.”

The problem came into sharper focus over the past year as doctors began seeking to meet the latest stage of the electronic health records incentive program. It requires them to share data with other doctors, and to do that they need their software vendors to build computer interfaces.

In the past, doctors might have wanted the connections but weren’t obliged to have them. Now they have a hard time meeting federal requirements without them.

As incentive payments started to dry up last year, EHR vendors began to see fewer sales of new software. They seem to have become more reliant on consulting contracts and fees.

For example, EHR maker NextGen and its parent company saw sales revenue decrease from $149 million to $87 million from 2012 to 2014. The company’s data interchange fees, meanwhile, increased from $49 million to $67 million.

On a national scale, the fees mount up. If each of the country’s 230,000 medical practices pays $15,000, on average, to connect to a health exchange, the cost to the health care system is roughly $3.5 billion. Many physicians need multiple interfaces.

The ONC has a certification program that requires vendors to show that their software will enable providers to meet the requirements of the federal incentive program, which in its current stage includes the ability to share data.

But the office has no power to set or police the prices that vendors charge. That leaves Congress in a bit of a quandary. Should it intervene in the market?

“I realize that I have to pay a fee when I use an ATM that isn’t part of my bank,” said Burgess. “But you can’t just drop your EHR like a used car and get another one.”

The systems cost thousands or millions of dollars and take months to implement. The favored term for this condition is “market failure.”

“This should be resolved in the marketplace,” said Burgess. But if it isn’t, he said, “ what would legislation look like? We’re examining that question very closely.”

“Some would say, let market forces reign and it will take care of itself. But it will take care of itself only at the expense of the public good,” said Whitlinger, who compares the situation to the earliest days of cellphones, when those made by different companies couldn’t communicate with one another.

“I can understand why Congress finds this intolerable,” he said. “We deserve 911.”

Via Politico

Four actions to put health care on a path toward system-wide interoperability

Last year, I wrote about my sister-in-law Patricia who was pregnant with her first child and wondering how she could track health information for both her and her newborn. With this simple request, she was exposed to the state of interoperability in the health care industry.

She could not access her doctor’s electronic health record (EHR) through her personal health record, nor could she communicate electronically with her prospective pediatrician. At the time, it was a small concern, but that quickly changed after she delivered. Her newborn’s breathing problems prompted an extended stay in the NICU, multiple diagnostic procedures, consultations by numerous specialists and use of a host of monitoring devices in the hospital and following discharge.

Suddenly the challenge of interoperability was very real for her.

Many in the health care industry (and providers in particular) have long been frustrated by the lack of interoperability among health systems and IT vendors, medical devices and financial systems. Earlier this month, the Office of the National Coordinator for Health IT (ONC) took a step toward advancing interoperability by publishing the initial draft of “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap.”

The draft calls for ONC to ensure that four important actions are completed in the short term:

  • Establishing a governance framework for interoperability that includes “overarching rules of the road” and involves a public/private process for implementation
  • Improving standards and guidance so they are “scalable, high performing and simple”
  • Using policy and funding levers to create incentives to use common technical standards to share health information technology
  • Protecting privacy and security while helping health care organizations understand and abide by Health Insurance Portability and Accountability Act (HIPAA) rules1

Some items within the roadmap are particularly notable. This roadmap is the first detailed vision the federal government has provided to the industry of a path toward system-wide interoperability. The ONC has received criticism inside and outside the beltway for not taking a stronger stance on interoperability earlier in the Meaningful Use program.

The draft also outlines how health plans can help advance interoperability. As organizations move from a volume- to value-based reimbursement model that needs to rely on population health management to a greater extent, connecting clinical and financial data will be essential. As an example, health plans with a focus on value-based care could make interoperability a condition of participation for providers seeking to partner with them in new payment arrangements.

This roadmap also identifies where the current issues lie and what may need to happen to allow the industry to get there. The “Standards Advisory,” which ONC is now soliciting public comments on, provides some of those details. This model will allow the industry to identify where stakeholders agree and disagree on standards and encourages an open dialogue on how to reach consensus on the points of disagreement.

While the roadmap provides a number of answers, it also raises a number of questions:

  • How will medical devices fit in? This roadmap focuses primarily on EHRs, but some providers struggle to integrate data from a wide range of devices. Integrating medical devices is very costly for health systems but can also impact patient safety.
  • What will be the future of health information exchanges (HIEs)? This perennial question around the purpose and sustainability model of HIEs becomes more acute as one of their primary functions – combining data in one place – may be rendered unnecessary by systems that speak with each other seamlessly.
  • Will EHR vendors have to change their systems or even their business models? The value of many lies in the comprehensiveness and integration of their various modules. How will free flow of data across vendors impact this competitive edge? Will interoperability become an opportunity for smaller players and will it help foster innovation generally?
  • How will the roadmap be enforced? Who will enforce agreed upon standards? How will we know when interoperability has been achieved? Simply certifying technology against criteria is not the same as certifying that something actually works. Health care may draw on experiences from other industries that have adopted centralized labs to test products in a real-world environment to measure this.
  • What will be the broader impact on the health care ecosystem? Information flow is not just about solving technical issues of interoperability, but also touches on complex regulatory, privacy and commercial factors.

Thankfully, Patricia’s son made a complete recovery and is thriving today. The ONC has declared a goal of 2017 to achieve significant progress, so hopefully by the time he is ready to go to pre-school, many of these issues will have been resolved.

via Deloitte »