Interoperability top of mind in 2013
From the start, 2013 brought more focus to the issue of interoperability than ever before, and there is no sign the interest will abate. After all, interoperability is critical to data exchange.
In the first week of January, Health Affairs ran a commentary by two Rand Corp analysts arguing that the predictions of cost and productivity benefits from EHRs haven’t materialized. Arthur Kellermann, MD, and Spencer Jones wrote that EHR disconnectedness was so common it “can be a problem even when two organizations acquire the same health IT system from the same vendor.”
[See also: HIE, interoperability still center stage.]
By March, Allscripts, athenahealth, Cerner, CPSI, Greenway and McKesson launched the CommonWell Health Alliance, promising to develop “interoperability for the common good” and “create universal access to individual’s health information.” CommonWell represents about 42 percent of the acute EHR market and 23 percent of the ambulatory EHR marke, and in late December announced its first rollout of interoperability services in Chicago, Elkin and Henderson, North Carolina, and Columbia, South Carolina.
Throughout 2013 and before, the nation’s then-health IT czar, Farzad Mostashari, MD, was trying to get hospitals and technology companies to adopt the idea of "HIE as a verb," and to abandon traditions of “hoarding” patient data. "We cannot have it be profitable to hoard patient information," he said.
Now a Brookings Institution fellow, Mostashari oversaw the creation of regulations for the second phase of the EHR meaningful use program with heightened health information exchange standards, and he laid a vision for the goals of the third phase. As the issue of interoperability drew its own attention, Mostashari tried to spur a conversation on policy solutions through the federal rulemaking process. Looking several years into the future, to 2016 and 2017, the ONC’s meaningful use workgroup is floating ideas for policy objectives from the final phase of the program:
For health information exchange organizations, helping providers and payers achieve those and other connections represents the long-term opportunity, especially as federal seed funding ends. As Chilmark Research argued earlier this year, 2013 marked a year that HIE organizations broadly tried to pursue HIE 2.0 after realizing they need to support care coordination and clinical network management, and by their reading in July 2013, only six vendors had surpassed HIE 1.0.
[See also: Whose data is it anyway?.]
Amid all of that, the idea of HIE as a mobile solution with “patient-mediated exchange” gained even more traction in 2013, poised to become at least a small part of the nation’s health information network. Mostashari called the “HIE of one” model “possibly the most disruptive, in a good way, that may really accelerate far beyond what we could accomplish.”
On the issue of interoperability broadly, Mostashari called on IT companies, providers and the government to see it as "shared responsibility." Fundamentally, we have to reduce the cost and complexity of interface."
Likewise in the public sector. As 2013 drew to a close and Congress’s long storm of disfunction cleared to allow a two year budget to pass, lawmakers specializing in military and veterans affairs took the Pentagon and VA to task for failing to nurture any meaningful interoperability, writing in the 2014 Defense Reauthorization Act that the agencies “have failed to implement a solution that allows for seamless electronic sharing of medical health care data” and setting an interoperability deadline of December 2016 for either an EHR shared by the two agencies or a seamless, interoperable connection. The VA and DoD now have to give Congress an interoperability plan by the end of January 2014, or otherwise face new funding restrictions.