The question came from Scott Jens, founder of RevolutionEHR for optometrists. Faulkner asked how many optometry records vendors there are, and Jens said about 30. That kind of software sprawl exists in every specialty practice area. If Epic worked on interfaces for all the vendors that wanted to integrate, "we would do no more development on our software," Faulkner said. "All we would do would be interfacing to the other vendors. … We would need thousands of programmers just to be on top of that."
Q: Is some kind of central repository for some core health data the answer?
Such a repository would face the same challenge Epic does in contemplating integration, said Faulkner: Does that repository have an army of developers to write and maintain all the necessary interfaces to the systems that will contribute data?
Ferguson at Kaiser Permanente was unequivocal: "Bad idea." One, he said, a central repository is a huge breach target. Two, the opportunity for conflicts of interest are insurmountable. Three, the expense is unsustainable to maintain a big central repository and normalize all that data. Instead, the better option is standards-based exchange efforts, such as the national e-health exchange started by ONC.
Q: Is the answer a simpler download to a personal record, so people do their own aggregating of health data sources?
Kaiser Permanente has let people download their own record for years, but there isn't an easy way to transfer that mass of data into a third-party, consumer record. "The technical barriers are way too high today," Ferguson said.
The list of independent, consumer-focused personal health records that have flopped is long and distinguished, including both Microsoft and Google. Byrne is betting on EHR vendors providing access via PCs or smartphones, such as Epic's MyChart service. Given the parade of failed personal health record startups, "I like my chances better picking up my iPhone and pulling up MyChart, and I can do that today," he said.
Q: What other barriers are there to interoperability?
Financial incentives are one barrier, Ferguson said, because fee-for-service medicine doesn't provide the incentive for sharing information. Accountable care and integrated care models have "native incentives for having complete information and sharing," he said.
Faulkner listed several barriers. One is patient control, which Epic hit with its earliest efforts to allow data transfers. "What we found right away is people wanted to share with people they felt comfortable sharing with and not with others," she said.
Another is lack of training, she said. Emergency rooms generally are steeped in how to exchange data and gather what they need, but there are many other areas that could use Epic's interoperability platform where they aren't trained in data exchange. Ferguson seconded the training obstacle, saying it's particularly tough in settings where clinicians only rarely exchange data and thus struggle to remember how to do it. "That's one of the reasons we have such low exchange rates even where the technical capability exists," he said.
This isn't a comprehensive list of barriers to interoperability, only some of the highlights from a good discussion. Are there others you would add? Please share them in the comments below.