It’s a relief to see Washington finally take much-needed action on meaningful use, with U.S. Senator Lamar Alexander’s recommending the delay for Stage 3, because forcing it now would drive the entire system to its knees. We all agree that the industry needed to change, and I am not criticizing the goals of meaningful use (Stage 1 — Data Aggregation & Data Access; Stage 2 — Healthcare Information Exchange and Care Coordination; and Stage 3 — Outcomes Improvement). This has been a bi-partisan initiative that started with President Bush and David Brailer, the first Health Information Technology Coordinator back in 2004, and has continued under The Office of the National Coordinator for Health Information Technology (ONC).
My extreme disappointment is because we did not pay attention to the first pillar —Data Aggregation and Data Access — to achieve outcomes improvement, which cannot be accomplished without clear and aggressive guidelines on interoperability requirements. Instead, the effort was directed to the implementation of electronic health records (EHRs) for data entry, which created silos around disparate vendors. The consolidation and collaboration of healthcare providers that resulted from the Affordable Care Act (ACA) exposed the failures of Stages 1 and 2 around interoperability.
If the right level of interoperability is not established early in the program, the healthcare system cannot easily migrate to Stage 2. The only data available is now centered on very limited interoperability standards of Consolidated CDA (C-CDA) & Health Level Seven International (HL7) and to the Fast Healthcare Interoperability Resources (FHIR) — which should be called SHIR for Slow Healthcare Interoperability Resources. FHIR is promising, but it is limited. Knowing that we are moving to value-based reimbursement, we need to realize that many of the top vendors have developed tools for their own customers to query the data. They are not opening up these tools to the rest of the industry. We need to create a temporary layer for all of us to collaborate on.
The ultimate goal should be for the vendors to be “open” and provide an EHR application programming interface (API) that makes all of the data contained in the EHR available to external systems, and to allow data to be input into the EHR by external systems. While there are no established industry standards for an “open EHR API,” interoperability is about having access to all clinically relevant data supporting multiple clinical workflows throughout the continuum of care, rather than limiting the available data to those parameters only supported under C-CDA, HL7 and FHIR. In order to complete the care coordination loop, having the ability to write back into the source systems is essential for the care team.
Interoperability should strengthen the role of the EHRs and give the healthcare system sufficient access and control to innovate around healthcare system-chosen initiatives (i.e. mobile technology, analytics, etc.). Rather than immediately addressing the issue of limited access to clinically relevant data, the ONC came up with a 10-year road map that brings the industry to where it needs to be at the end. It ignored, how we get there. To top it off, the push to Stage 3 —Outcomes Improvement — would force the ongoing move to a value-based reimbursement model without giving caregivers access to clinically relevant data to make informed decisions —again exposing the limited success of Stage 1.
It seems as if developments are now moving at “Washington speed,” driven by political elections and not the original mission and vision of the meaningful use program. It is time for the government to start listening to the providers and patients, not the vendors. This could be a win/win situation: providers and patients know what is good for the industry, and can help get the politicians the votes they need.
With more than 25 years of healthcare industry experience and a passion to lead via disruptive and continuous innovation, Alan Portela is the CEO of AirStrip, a position he has held for more than four years. Before joining AirStrip, Mr. Portela was the President of CliniComp, Intl. and previously led the implementation of high-acuity EHR systems at the U.S. Military Health System, Veterans Health Administration (VA) and a number of prestigious healthcare organizations in the private sector. Mr. Portela has held senior executive roles with a number of innovative healthcare technology vendors and was among the leaders who pioneered Global Care Quest, an mHealth company that emerged from UCLA Medical Center Department of Neurosurgery more than a decade ago.