By Sally Buta
In any discussion of healthcare IT and electronic health records (EHR) systems, nothing sparks more contention than the “i” word: interoperability. That this is the case after five decades of computer usage in healthcare delivery represents a sad state of affairs indeed; it is well past time for the health IT industry to clean up its interoperability act.
The first large-scale EHR system deployments occurred in the early 1970s, most notably the U.S. Department of Veterans Affairs VistA system. Today, nearly all U.S. hospitals and most medical practices have moved to using a certified electronic health record (EHR). This is a nine-fold increase in EHR usage since the HITECH Act became law over 10 years ago. So healthcare is well down the path toward “digitization”.
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Still, interoperability – widely recognized as a key to unlocking the value of digitization – remains elusive. Interoperability in health IT has been discussed forever, yet last year ONC reported this sad news to Congress:
“Health care providers often lack access to patient data at the point of care, particularly when multiple health care providers maintain different pieces of data, own different systems, or use health IT solutions purchased from different developers…”
Virtually everybody agrees that, conceptually at least, interoperability is a good thing. It will contribute to patient safety and continuity of care – by enabling patients to manage their health better, and putting current and accurate patient data in the hands of every healthcare provider when and where they need it – as well as promote cost savings for provider organizations and the overall healthcare ecosystem.
Technologically, however, interoperability is complicated. And in the marketplace, the proprietary commercial interests of EHR vendors and healthcare networks still stymie health information exchange, and reports of information blocking are common.
As a result, the process of creating interoperability standards has become highly political. As proof, consider that the very definition of “interoperability” is set forth in federal legislation -- section 4003 of the 21st Century Cures Act:
Health information technology that "(A) enables the secure exchange of electronic health information with, and use of electronic health information from, other health information technology without special effort on the part of the user; "(B) allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable State or Federal law; and "(C) does not constitute information blocking as defined in section 3022(a)."