'Physicians shouldn't be struggling with this stuff'

EHR roadblocks holding docs back

By Sherree Geyer
10:02 AM

Anna Orlova, senior director, standards at AHIMA, compares the current interoperability of today's electronic health record systems to treadle sewing machines of the early 20th century.

"What we give physicians is a mechanical sewing machine," she says. "You just need to move your legs to create data. It shouldn't be that way."

Steven J. Stack, MD, president-elect of the American Medical Association, says difficulties exchanging and sharing data stem in large part from "an overabundance of measures with specifications that are unaligned," creating confusion for overburdened physician practices.

"A recent study found this uncoordinated approach resulted in too much variability in the large array of measures being promoted across the healthcare system," says Stack.

The study in question – "Effects of Health Care Payment Models on Physician Practice in the United States" – finds physicians faced roadblocks to data analytics caused by missing quality performance feedback or drug prices. The joint effort with RAND Corporation recommends addressing physician concerns about operational issues to improve the effectiveness of alternative payment models.

"The underlying problem is EHRs don't talk to each other very well," says lead author Mark Friedberg, a senior natural scientist at RAND. "The analogy is to train tracks. Each EHR is different," says Friedberg who notes that interoperability "has never been incentivized by the Office of the National Coordinator for Health IT."

Orlova underscores the importance of getting interoperability standards back on track.

"In the past six years, we've seen a derailing of government as leader in the private-public partnership of developing standards needed by physicians," she says. "We're so far behind half the world. Estonia is ahead of us."

Immature standards prevent existing health IT systems from cooperating, she adds.

"The government doesn't mandate standards," says Orlova. "We need to create interface standards for semantics, technical and functional." Instead, she points out, "standards today exist only for technical" aspects of interoperability.

Stack agrees. "Many of the exchange requirements and functional objectives, identified in these programs, are based on immature standards that are untested, under-developed or lack market consensus," he says.

"The federal government could incentivize and direct healthcare interoperability through policy measures, such as meaningful use and the standards and interoperability framework, originated by the Health Information Technology Policy Committee.

"For the most part, data is being exchanged between EHRs in the form of large, unwieldy, multi-page documents that provide little value to physicians or their patients," says Stack. "ONC's certification program currently does little to ensure the successful end-to-end exchange of data between sites and services."

Meaningful use, he says, "has hindered, rather than bolstered (interoperability) across the nation."

However, Friedberg calls EHR certification one way interoperability could be enforced.

"Using the railroad analogy, all tracks have to have the same grade," he says. "For physicians to receive a bonus through meaningful use, they have to use certified EHR. Conceivably, that could put pressure on EHR vendors to become certified and ensure physicians are meeting MU requirements."

Orlova says it's a "crime" to put interoperability requirements in place without certification. "Certification must be in place and we have a good example of this in the IRS," she says. "Every time we file our taxes, we're certifying that we did it to the best of our ability."

Stack calls medical coding diagnostic changes in October "one more burden facing physicians," noting that "every certified EHR needs to have updated software to handle ICD-10 coding. There could be a considerable number of challenges during the transition.

"If a vendor doesn't have updated software ready, installed and deployed in time, physicians will be out of compliance with HIPAA and risk significant processing and financial interruptions," he says.

Simply put, "physicians shouldn't be struggling with this stuff," says Orlova. She believes that "the current ONC administration and Congress understand the role of government as leader and facilitator." She expects collaboration between the AHIMA and HIMSS will result in a blueprint for interoperability standards within two years.

"Five years from now, we'll see activities take off," she says. "We're working to make this easier for physicians, as well as HIMSS. We have to be patient, but we know where we're going."

"Chasing data for uncoordinated measures requires significant time and resources that could be better spent on patient care or technology that practices need to achieve desired outcomes for patients," says Stack. "Efficient data flow is key. Data must drive the rapid cycle design and implementation of quality improvement efforts."

Friedberg thinks the best use of federal energy would be "in areas where there are needs for massive coordination. If everyone's off playing their own instruments, they need a conductor. Government could be that conductor."