CIOs tell ONC: It's time to let the EHR market innovate to drive interoperability

Several experts contend that the Office of the National Coordinator for Health IT is attacking the wrong problems and the last thing anyone needs is more prescriptive regulation about EHR functionality, usability and quality measurement.
By Diana Manos
07:39 AM
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ONC EHR interoperability

DirectTrust CEO David Kibbe, MD, said that the federal government and healthcare industry need a new dialogue about how health data is centralized, de-centralized, secured and accessed. Source: Senate.help.gov. 

The time has come for the Office of the National Coordinator for Health Information Technology and other federal regulators to back off trying to “fix” interoperability with regulations, and let the market solve the problem, according to several industry leaders.

“It’s time to return the agenda to the private sector and let clinicians drive vendors to produce the products and services they want,” said John Halamka, MD, chief information officer of Beth Israel Deaconess Medical Center and co-chair of ONC’s Health IT Standards Committee.

David Kibbe, MD, president and CEO of DirectTrust, a collaborative non-profit association of 145 health IT and healthcare provider organizations in support of secure, interoperable health information exchange via Direct message protocols, added that the lack of success so far with interoperability is not a technological problem, rather it’s a social issue.

“We’ve got the wrong problem in mind, and it’s distracting us from getting to the root causes of our discomfort,” Kibbe explained. "The real issue involves who owns the health information that is created by you and me, and about you and me, and who has the rights to view it, access it, use it, download it and move it around.”

Initiatives already underway
The answer to the problem lies in returning the power to control medical records to the patients; it shouldn’t be in the hands of providers, EHR vendors, researchers or the government.

“We need a new and different national, maybe international, dialogue about how health data and information are centralized and de-centralized, about how to assure its privacy, about the use of encryption for security and about identity assurance,” Kibbe added. “Some of this is policy and some of this is social science.”

[Also: Is EHR data blocking really as bad as ONC claims?]

The College of Healthcare Information Management Executives, for instance, is focused on finding solutions to creating a truly interoperable delivery system, notably a national solution for patient identification to help match people with their medical records, said CHIME spokesman Matthew Weinstock.

The Center for Medical Interoperability, meanwhile, is currently working on interoperability by leveraging the power of purchasing power and it is in the process of gathering top interoperability experts and providing a research venue for them to create an interoperability blueprint, said Vice President of Public Policy and Communications Kerry McDermott.

The organization’s health system membership represents the bulk of electronic health record purchasing power, and it hopes to use that power to harness innovation from researchers in other fields that have already mastered interoperability.

“Folks are coming to the place where they want to and need to exchange data,” McDermott said. “And they are struggling with best means of doing it.”

The future promise of changing payment models
The shift to value-based care and reimbursement, as will be needed under the Medicare Access and CHIP Reauthorization Act, or MACRA, is poised to quickly force the industry to find ways to share data more effectively, McDermott added.

BIDMC CIO Halamka agreed that MACRA and the Merit-Based Incentive Payment System hold the potential to usher in a new era of technologies.

“We’re on the cusp of real breakthroughs in EHR usability and interoperability based on the new incentives for outcomes suggested by MACRA and MIPS,” Halamka said. “But the worst thing we could do at this time is to co-opt the private sector agenda with more prescriptive regulations about EHR functionality, usability and quality measurement.”

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