The Interoperability Impasse – Both EHR Developers and Healthcare Providers to Blame

by | Published on Nov 6, 2017 | News

The EHR was welcomed with mixed response throughout the United States, with none being completely confident about its capabilities and risks. Physicians and other clinical professionals, patients, attorneys, and providers of medical record review for attorneys among others need to handle medical records and the ease of sharing information is something that all of them welcomed. EHRs promised the easy collection and analysis of vast amounts of data with a view to improving performance reporting, disease management and patient outcomes. However, it has now come to light that the way EHR systems are implemented and managed make it difficult for healthcare providers to share the health data with outside organizations including registries. This has led to data blocking, and a curb on the amount of healthcare data that flows to patient registries. When data is incomplete, a comprehensive picture of patient medical records is not available and this beats the very purpose of the EHR.

Lack of Interoperability Affects 3 Major Areas

According to the ONC (Office of the National Coordinator for Health Information Technology), the most common instances of information blocking are targeted toward the health IT developer. It is alleged that EHR vendors create systems that will not exchange information with other systems. In addition, they charge fees for sharing information thus creating a cost barrier to information sharing. The impact of data blocking is felt across the following areas.

  • Chronic care management: Managing chronic health conditions such as diabetes, high blood pressure, asthma, COPD and so on requires huge amounts of health data that can be used to track trends and bring about changes in the way chronic diseases are treated and managed. Data is vital to identify at-risk patients and providing intervention and support services. This means that healthcare organizations that have disparate systems and varying data formats must find a way to aggregate and share the data.
  • Performance reporting: Medicare and Medicaid incentive programs that aim to achieve patient and practice improvements under value-based care initiatives need a novel approach to measuring success and receiving full reimbursement based on improved patient outcomes. All these programs call for free transmission of data between providers and public health information exchanges. Registries that are intended to derive insights from available data need to collect good quality data. If that is not possible, it will inhibit physicians from reporting the data needed to receive reimbursement. Providers responsible for reporting patient data to the government with MACRA legislation will be especially affected by this.
  • Improving patient outcome: Access to health data is vital to improve patient outcomes. Existing and available data can help with identifying cures for some of the most common and chronic health conditions. Data contained in registries can be used to improve the safety and quality of therapies and medical devices.

EHRA Gives Vendors a Clean Chit

The EHR Association (EHRA) Executive Committee however, responded to the allegations against EHR vendors, calling the assertions “inflammatory and inaccurate.” They pointed out that the accusations undermine the progress EHR vendors and regulatory bodies have already made toward enabling interoperability. They admitted that more improvements are required before health data exchange reaches full maturity, and said that interoperability is definitely growing quickly between providers and patients. According to them,

  • Regarding information exchange between clinicians and their patients, the latter have broad electronic access to the information in their provider’s EHR.
  • All certified EHRs make available clinical summaries in a readable format based on the standards adopted by the ONC via the View, Download, and Transport capability, typically via patient portals.
  • The widespread use of APIs (application programming interfaces) to access health data coupled with new regulatory approaches should further accelerate and bolster existing progress.
  • Vendors always allow data sharing with registries irrespective of whether the registry is a customer, as long as the registry is willing to share information using standards-based tools and data requirements.

The EHRA said that if the registry uses a non-standard information exchange approach or requires data elements not captured in the provider’s clinical workflow, there may be fees for the creation of any required interface or any customization necessary to collect additional data, apart from the normal fees for integration with the registry, and this would depend on the particular EHR’s architecture and business model. They point out that charging a fee for customization, additional data collection, or data integration with the registry doesn’t constitute information blocking. They argue that just as other capabilities such as software development and services have associated charges, the same allowance should be given to products and services oriented towards information exchange, taking into consideration developers’ costs and related investments to provide those capabilities. The EHRA expressed a belief that existing regulations including those related to HIPAA, HITECH, and the 21st Century Cures Act are sufficient to prevent information blocking. According to them, penalizing health IT developers and providers for interoperability problems or mistakes cannot bring about improvements in health care or ensure better outcomes for patients.

What ONC Plans to Implement to Prevent Information Blocking

When it comes to information blocking, the ONC says that many actions that prevent data exchange may be inadvertent, stemming from economic, technological, and practical challenges that have for long prevented effective and widespread information sharing. Then again, even conscious decisions that prevent information sharing may be motivated by, and promote important interests such as protecting patient safety and improving health and health care. Not all hindrances to information blocking are related to HIPAA or have a technical nature. According to the ONC, unreasonable contract terms, selling IT products that require add-ons, inflated data exchange fees, complex workarounds, and developing products that “lock in” providers to systems that obstruct the flow of information are among the major obstacles to smooth interoperability.

Not only EHR developers, healthcare providers also are seen to block information exchange. Patient data is deliberately withheld to control referrals, keep patients within the network, and boost market dominance. In this case, large healthcare systems are found to be particularly at fault. Though they exchange electronic health data internally, they may be reluctant to share it with competing hospitals and unaffiliated providers. The ONC has plans to:

  • Increase monitoring and surveillance of certified EHR technology (CEHRT) as it is used in real-life situations
  • Put meaningful consequences including decertification, on the table
  • Include more stringent requirements for the use of data standards and transparency
  • Make more explicit what constitutes data blocking and inadequate health information exchange
  • Coordinate with the HHS Office for Civil Rights (OCR) to clarify HIPAA provisions that do and do not permit the sharing and disclosure of personal health information
  • Coordinate with the Office of the Inspector General (OIG) to ensure that developers and providers are adhering to federal anti-kickback rules and physician self-referral laws.
  • Encourage innovation and healthy competition between health IT developers to improve data sharing and exchange of information across standards-based systems.

Interoperability is vital for processes such as medical peer review and medical records review among other important functions in the healthcare industry. Information blocking is indeed a serious problem that needs to be effectively addressed. It is the hope and belief of all stakeholders that the ONC will implement a comprehensive strategy that will substantially reduce the major roadblocks in the way of meaningful sharing, while at the same time allow healthcare providers and EHR developers to retain their competitive edge.

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