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    There needs to be accountability for the lack of interoperability

    Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Keith Aldinger, MD, an internist who practices in Houston Texas. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


    It has been 12 years since Rand Corporation published a study in Health Affairs extolling the values of a wide adoption of Electronic Health Records (EHR).[1] However, 12 years after the fact, the IT industry has seemingly missed the main point.


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     In the opening section, it addresses the potential savings, costs and safety benefits. In the sentence that follows, they define what is meant by the word potential,  “assuming interconnected and interoperable EMR systems are adopted widely and used effectively.” In the concluding section, it states, “also, even if EMR systems were widely adopted, the market might fail to develop interoperability and robust information exchange networks.”

    Obviously, in the study, interoperability was an important and probably the main driver of cost savings. So where are the IT vendors on interoperability? The answer is probably close to nowhere.

    In a recent study that appeared in March of 2017, investigators at the University of Michigan conducted a survey of Health Information Exchanges (HIE) nationwide that addressed their experience with information blocking.[2] Fifty percent of respondents reported that EHR vendors routinely engaged in information blocking and 33% reported that EHR vendors occasionally engaged in information blocking.

    For hospitals and healthcare systems, 25% were reported to routinely engage in information blocking and 34% were reported to occasionally engage in information blocking. When the survey asked about the form of information blocking used by EHR vendors, 49% reported products with limited interoperability and 47% reported that vendors routinely or often charged high fees for health information exchange unrelated to cost.


    IN CASE YOU MISSED IT: Switching EHRs becoming norm in healthcare


    Obviously, the EHR vendors appear to be the main source of information blocking and limited interoperability is the most cited method. I would draw your attention to the statement by the Certification Commission for Health Information Technology (CCHIT) which listed the criteria that would take effect on July 1, 2009, for Certification of Ambulatory EHRs.[3] It lists three areas, functionality, interoperability, and security. Under interoperability it states:  “the ability to receive and send electronic data between an EHR and outside sources of information such as labs, pharmacies and other EHRs in physicians’ offices and hospitals.” This appeared sometime prior to July 1, 2009. The University of Michigan study above appeared in March 2017. That would be at least 7 years, 8 months after the CCHIT requirements for interoperability were set to take effect.

    Next: 'How is it that certified EHRs are still not interoperable?'

    Keith Aldinger, MD
    Dr. Aldinger is an internist who practices in Houston, Texas.

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    • [email protected]
      Doctor Keith, right on the point; we have been using an EMR since 2000; it was developed by my wife, an internist; we have had 6000 patients on it for years; it is slick, fast, disease management based, and user friendly; our transcription service ended two weeks after we started the software called Isprit; the problem is certification and interoperability; the "big guys" pushed for expensive certification to crowd out the little guys; each vender program is proprietary and "secret" so therefore, will not allow for "talking" between the software programs; how right you are in stating we physicians suffer the wrath of the government while the software companies get away with non compliance; we are done with "meaningless use", anyways, and have gone to Direct Primary Care , free of the curses and reprimands of the government and insurance companies; we work for our patients now and no one else; great article, good luck, [email protected]

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