Senate Committee Seeks EHR Interoperability Investigation - InformationWeek

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7/26/2014
08:36 AM
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Senate Committee Seeks EHR Interoperability Investigation

Bipartisan Senate Appropriations Committee wants an investigation into poor interoperability, possible "information blocking" in electronic health records.

talking about the money that was spent on the health information exchange program, which would facilitate finding key patient information when it is needed," he said. "I hope any oversight looks at [whether] so-called information blocking has impacted the use of that money."

Records also should be accessible, regardless of vendor software, through each state's health information exchange (HIX), said Mansur Hasib, author and longtime healthcare CIO. While states such as Maryland and Delaware lead the way, others' HIX adoption lags, damaging patients and providers, he told InformationWeek.

"All these health information exchanges that are being built were supposed to really help with this interoperability. All the states do not have working health information exchanges and that's a big problem. Is that a federal government issue? I don't think so," said Hasib. "Blaming the federal government for this is really not going to be fair because they don't control the state governments. The only thing they can do is provide the money -- and they have provided the money."

Next steps
In its comments, the Senate Appropriations Committee outlined several steps the ONC should take. These include:

  • Using ONC's authority to "certify only those products that clearly meet current meaningful use program standards and that do not block health information exchange."
  • Decertify products that proactively block information sharing.
  • Provide the committee with a detailed report on the extent of information blocking within EHRs, including the number of vendors, hospitals, and providers involved, and ways to address the issue.
  • Within 12 months of enactment of the act, ONC should submit a report to the Senate Committees on Appropriations and Health, Education, Labor, and Pensions on the challenges and barriers to interoperability. It should address technical issues, operational impediments, financial hurdles, the role of certification, and any other obstructions.

If there is any truth to the allegations of information blocking, the ONC should not lead this investigation because it only runs the EHR certification program and the department has limited responsibilities by law, said Bialick.

"What I took away from the hearing is that this practice of information blocking is using taxpayer dollars to further a business practice that undermines congressional intent. If that is the case, then this should be investigated, very publicly, by the Energy & Commerce Committee in its Oversight capacity," he said. "Keep in mind that the technologies doing this supposed blocking are totally in compliance with the regulations set out by the HHS. It is contracting and business agreements that are blocking the data; this is to say that ONC likely does not have the legal mandate to address this issue."

If blocking is part of EHR development, participants are seriously damaging patients and providers. Doctors cannot trust they're seeing an entire patient record, for example, Bialick said. Patients might unnecessarily repeat expensive or dangerous tests, he added.

"The patient safety movement believes that device and EHR interoperability is key to developing patient safety systems that can aid healthcare professionals in their clinical decision making to stop threats to patient safety before they happen," Bialick said.

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Alison Diana has written about technology and business for more than 20 years. She was editor, contributors, at Internet Evolution; editor-in-chief of 21st Century IT; and managing editor, sections, at CRN. She has also written for eWeek, Baseline Magazine, Redmond Channel ... View Full Bio

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Alison_Diana
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Alison_Diana,
User Rank: Author
7/28/2014 | 9:28:59 AM
Re: I've worked in Healthcare software for over 10 years now and..
Everything you say is so true. Every healthcare CIO I speak to cites "finding and retaining top IT talent" as their No. 1 challenge. Every project is a priority -- until, like ICD-10, it isn't. The change to value-based pay, meaningful use, and everything else plus typical business issues (like the ones you describe so well, such as bad debt) make this an extremely challenging environment. That's why I hope vendors, payers, providers, etc., can work together more seamlessly (with or without government oversight, although it sounds as though it's missed the boat in terms of no oversight) on really improving EHR interoperability so that's one less thing for strapped HIT departments to deal with.
Alison_Diana
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Alison_Diana,
User Rank: Author
7/28/2014 | 9:25:00 AM
Re: Spiteful, Obstinant & Futile
The high cost of self-pay insurance was one major reason I returned to corporate work after 10 years as a successful freelance writer and editor, so I know exactly what you mean @Gary-El. Three years ago, I spent about $600 per month to insure me and my daughter; it was good insurance, but didn't include maternity or anything related to that (fortunately, my husband and I didn't want any more kids) and no dental.

That said, interoperability between EHRs is one of the primary selling points of electronic records. Without this, EHRs -- while still an improvement over paper records -- are simply digital versions of last decade's folders. As my story said, patients believe records are complete and transferable so mistakes will (and do) happen, resulting in injury/sickness/death. The fault for those negative results falls on someone other than the patient. IF there is wilful prevention (and that's a big "IF"), then it has to end. Now. If it's simply an overly complex problem, then it must be simplified. Fast.
progman2000
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progman2000,
User Rank: Ninja
7/28/2014 | 9:21:47 AM
Re: I've worked in Healthcare software for over 10 years now and..
There are a lot of dynamics at play here, and suffice it to say that our Healthcare system is severely screwed up.  Hospitals rely in a huge extent on payments from insurance companies, and insurance companies have a living matrix in place to make it as hard as possible to pay for claims.  Plus hospitals take a huge bath on charity care patients and bad debt in general.  So the money left over for IT projects is always sketchy, and top talent is not exactly working at hospitals as a result.
Alison_Diana
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Alison_Diana,
User Rank: Author
7/28/2014 | 9:19:18 AM
Re: Spiteful, Obstinant & Futile
Some of these issues do seem to be more political than having anything to do with vendors. It's always easy to take a potshot at EHR developers, but I agree with you and Mansur who was quick to point out that HIXs -- and states' differing acceptance/adoption and rate of successful rollout -- have a lot to do with providers' ability to read disparate systems/providers' records. I don't know which states might be worse at HIX than others or whether any are 'proactively blocking' integration efforts but this would have to be part of any investigation into EHRs.
Alison_Diana
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Alison_Diana,
User Rank: Author
7/28/2014 | 9:16:06 AM
Re: I've worked in Healthcare software for over 10 years now and..
I gather EHR interoperability has improved a lot but, compared with other industries, healthcare is severely lacking -- and that is what lawmakers in this committee appear to be frustrated and angered by, especially as taxpayer money has paid for so much of this investment. As one of those taxpayers, I'm glad it's getting scrutiny. 

It's unsurprising to me: We've seen this before in other industries where vendors and/or participants were slow to work with competitors on sharing information. Once end-customers (patients) grew louder in their complaints and some customers (providers) got upset, steps were made but they weren't fast or deep enough, compared with other industries. When an industry doesn't take enough steps, fast enough, voluntarily, government usually steps in with a big stick. If you look back, pundits have warned of this eventuality for years. And here it is, apparently.
Gary_EL
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Gary_EL,
User Rank: Ninja
7/26/2014 | 10:50:11 PM
Re: Spiteful, Obstinant & Futile
I hadn't thought of that before. Deliberately installed roadblocks could well be a significant reason for the slow progress of interoperability between the EHR systems. If someone who's loved one died because of this makes enough noise about it and prosecutors can make a good case of it, I'll cheer more loudly than anyone else as the perpetrator is hauled off to prison

Obamacare is saving me a fortune, because, as a freelancer, I can no longer be forced to pay ruinous rates for individualized policies, and if any of you are paying a bit more because you can't steal from me any more, well, isn't that just too bad?
asksqn
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asksqn,
User Rank: Ninja
7/26/2014 | 3:45:17 PM
Spiteful, Obstinant & Futile
I'm curious as to which states are using software that blocks the ONC API necessary to interact with the larger Obamacare HIX? I'd wager every single one of them has or is continuing to obstinantly not participate in the federal exchange, which, at this point, is utterly futile.  As much of a steaming pile of fail Obamacare is, the fact is, it's not going anywhere antime soon.  To continue blocking API interactivity is simply punishing average Joe Americans whose only "sin" is that their regular insurance was taken over by Obamacare.
progman2000
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progman2000,
User Rank: Ninja
7/26/2014 | 10:28:04 AM
I've worked in Healthcare software for over 10 years now and..
I can honestly say that interoperability has improved quite a bit the last several years.  Not at the speed it would in the non-healthcare world necessarily, but nothing ever moves at that speed within healthcare IT.  That said, I remember just a couple of years ago being frustrated because so many of these systems operated as a "black box".  Now, they all (for the most part) integrate pretty freely.
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