Interoperability: Quick Route To Better Care

Critic chides policymakers for downplaying standards and usability in Meaningful Use Stage 1 at American Medical Informatics Association meeting.
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Healthcare quality and efficiency could move forward 20 years in a matter of months if only there were true interoperability of electronic health information, according to a noted critic of the health IT industry.

In the opinion of University of Pennsylvania sociologist Ross Koppel, interoperability would help unlock "rich, extraordinary data that would make medicine more wonderful." Koppel offered this assessment at last week's American Medical Informatics Association (AMIA) annual conference in Chicago, where he participated in a panel about why interoperability was "taking so darn long," as AMIA put it.

"I think we're working at the margins to address problems that are systemic and need to be addressed at the systemic level," Koppel told InformationWeek Healthcare afterwards.

During the session, Koppel argued that the Meaningful Use program that encourages adoption of electronic health records (EHRs) was based on an idea first floated three decades ago by health IT vendors to sell more software with the help of government subsidies. While the goals of Meaningful Use -- to improve the safety and efficiency of healthcare delivery -- may be noble, Koppel said that policymakers have been too focused on EHR features and not enough on usability.

[ How could patient engagement help transform medical care? Check out 5 Healthcare Tools To Boost Patient Involvement. ]

Koppel said that a 2009 New England Journal of Medicine article about EHR adoption in hospitals, written by then-national health IT coordinator Dr. David Blumenthal and a team from Harvard led by Dr. Ashish Jha, looked only at software features in defining a "complete" EHR. The study, which helped inform Stage 1 Meaningful Use regulations, did not ask at all about usability, patient safety, interoperability, data standards or what Koppel called "clunky interfaces."

If it had, Koppel said, policymakers may have seen how health IT has been burdened by too many standards and not enough cooperation among competing technology vendors and healthcare providers. He said that there are about 40 different ways to record blood pressure in EHRs. At least from an informatics standpoint, perhaps three of those ways are "proper."

As a result, in Koppel's opinion, the federal government has not done enough to encourage data sharing so far. In Stage 1 of Meaningful Use, health information exchange (HIE) is one of a menu of measures hospitals and physicians can choose from to satisfy the requirements, and, apparently, few did.

"It's nice and we might even save a few lives," Koppel said about increased EHR adoption from Stage 1, "but we can save millions with interoperability."

At least one vendor pushed back against Koppel's harsh criticism. During the session, Dr. David McCallie Jr., VP of medical informatics at Cerner, said that vendors large and small have teamed with the Office of the National Coordinator for Health Information Technology to create the Direct Project. Anyone can use the open-source system for secure health information exchange over the Internet, though McCallie acknowledged that it can be difficult to incorporate Direct Project protocols into EHR code and into workflows.

Koppel agreed with that assessment about the complexity of achieving interoperability, with so many IT components and "moving parts" like new test results, makeup of care teams, and changes in patient health conditions.

McCallie further noted the speed in which the industry developed the Continuity of Care Document, a key part of exchanging patient summaries, a requirement in Meaningful Use Stage 2. "It happened in two years, which in standards terms is lightning fast," he said.

Stage 2, which begins in less than a year for hospitals that reached Stage 1 in fiscal year 2011 and in January 2014 for individual providers who were early adopters, makes additional HIE measures mandatory. To Koppel, that represents long-overdue progress. "I really appreciate what has been done in MU2. It's a marked step forward," he said.

Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)

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