On Feb. 17, 2009, the American Reinvestment and Recovery Act was signed into law by the federal government. A portion of these federal funds was marked to increase the use of EHRs by hospitals and doctors (this portion of the bill is called the Health Information Technology for Economic and Clinical Health Act). Since that time, several other bills have passed, several health IT committees have been created, and billions of federal dollars spent all for this purpose. An important aim of this political agenda was to develop true interoperability throughout the U.S. healthcare system between disparate EHR systems.
Today, in 2017, there are a plethora of EHR products available, and the vast majority of them do not communicate with others. Doctors adapted EHR technology, largely against their wishes, and complied with government mandates, in the hopes of improving patient care. One such way we hoped to do that is by communicating with other doctors outside of our systems/hospitals/practices aka interoperability. We invested in false promises and hopes in this regards and are still being led astray by those promising interoperability in the near future.
Many health IT experts debate this very topic, yet lack real world experience in this endeavor. A good example is the patient portal. While many people believe this to be a revolutionary tool for patients, making it available is not a simple task. In my practice, it took almost two years to have a functioning patient portal, yet it was not from a lack of effort. We had two separate vendors for our website and our EHR. They kept promising to work together to build the bridge to make it happen. There were many supposed aborted attempts due to lack of technologic compatibility. In the end, they each wanted to sell us their own products (a new website, a new EHR) and refused to work together any longer. We only achieved a functional portal when we replaced them both, at a significant cost to us.
The labs and hospitals are another story. The bridge to connect those systems took months to create. The hospitals were unable to bridge with our EHR, but rather made their results available online, password protected. We need to login, download the results and then upload then to the EHR. We do not have full access to hospital records, only lab and radiology results. We do not have access to the medications or any notes if the patients were hospitalized. This still requires a phone call and a fax.
Many people will have you believe doctors are a big cause of the failure to reach interoperability. They think that we are slow to try new technology and we're all minted in the Mesozoic era. But, medicine is advancing faster than most other fields, Doctors are using new robots, new lasers, new tools, new technologies, and new medications all the time.
The problem is not us, but rather the health IT vendors themselves. Many people just assumed the reasons doctors did not want to jump on the EHR train. If they asked, they would know that we are waiting for the software that doesn't interfere with our workflows and for interoperability to be finally realized. I have been using an EHR since before it was the in thing to do and before the government issued their mandates on how to do it. It worked fine for me then because I used it on my own terms to create a usable medical record.
Why is interoperability doomed to failure?
- There are too many vendors with vested interests not willing to work together to create bridges needed to connect products.
- The vendors want the whole healthcare system to purchase their products.
- CMS is more interested in doctors’ billing practices than in helping create interoperability.
- Doctors no longer trust the EHR agenda and are pushing back against the whole industry.
- Insurance companies are invested in their bottom lines; patient outcomes are secondary. They do not have any incentive to have interoperable systems as long as they can get whatever data they want and EHRs have been making this easier for them.
- Politicians have their own agendas to cull favor among their voters. They have a utopian world-view and their reality is skewed. Just because they pass a bill doesn’t mean it will happen. It sounds nice on paper but someone has to make the effort to effect change. They have made nicely worded, extensive laws without any true means of achieving the goals.
While the interoperability debate rages on, there is no hope that we will see it any time soon. We need people to stop dreaming and put on their work gloves. To make it happen, people need to remember that the true aim of healthcare is about curing disease and saving lives. Interoperability is a means of improving patient outcomes by giving healthcare providers instant access to all a patient’s medical information.