'We need to keep the pressure on'

Interoperability (finally) takes center stage in Congress

By Erin McCann
10:29 AM
It's been almost six years since the Senate HELP Committee has revisited EHRs and interoperability, and at a hearing Tuesday on Capitol Hill, there was an overarching theme among industry stakeholders: that talk is long past due. 
We followed the near two-hour hearing that brought together physicians, researchers and vendor voices, and rounded up the big takeaways you should know about: 
The EHR Incentive Programs did some good. But not enough.
Sure, the Centers for Medicare & Medicaid Services has paid out nearly $30 billion in meaningful use incentives to date to hospitals and providers who have attested to meaningful use, but the regulatory requirements have been a constant burden for many physicians who are time and resource-strapped already. 
"The evidence suggests these goals haven't been reached," said Sen. Lamar Alexander, R-Tenn., chairman of the committee. (Some 50 percent of office-based physicians had adopted a basic EHR in 2013, up from 11 percent in 2006.)
Indeed, Robert Wergin, MD, president of the American Academy of Family Physicians, said that although family physicians have been on board with health IT since the beginning, they're having a difficult time with the Stage 2 meaningful use requirements. In fact, some 55 percent of physicians indicated they would be skipping Stage 2 all together. The "time, expense and effort it takes makes it not worth while," said Wergin. 
Interoperability needs to happen. Now.
What's more, as Wergin pointed out, is many docs may now have these EHR systems. But these systems don't even talk to each other.
"The issue of interoperability between electronic health records represents one of the most complex challenges facing the healthcare community," he said. The government "must step up efforts to require interoperability." This, he explained, should include HHS ramping up EHR certification requirements and delaying meaningful use penalties until interoperability is achieved. (Providers who didn't attest to Stage 2 are responsible for a 1 percent reduction in Medicare payments, with that number eventually increasing to 5 percent.)
But Julia Adler-Milstein, assistant professor of information at the University of Michigan's School of Public Health, who spoke before the committee, cautioned against eliminating these penalties, as it may have unintended consequences stymying progress. "If we pull the penalties back, I think there's a risk," she said. "We need to keep the pressure on." Instead Adler-Milstein said there needed to be more market incentives in place. 
EHR vendor business practices were called into question – big time. 
It came up again and again. Vendors have no incentive to share data and create more interoperable systems. There's the question of data ownership here. There's the question of competition. And there's the question of standards – or lack thereof.
"The vendors are siloed," said Wergin. "And you're held somewhat hostage by the vendor you have." Wergin, who's also a practicing physician at a small practice in Nebraska, said because the vendors operate on the belief they own the patient data, a "vendor lock" occurs, and negatively impacts care because patient data isn't shared properly. 
"In more competitive markets, hospitals don't want to share data," said Adler-Milstein. There's "no business case for interoperability," she said. Incentives can change that.
Epic thinks the cost of CommonWell's membership fee is a bit much. 
We're talking millions of dollars and a signed non-disclosure agreement, said Epic's interoperability chief Peter DeVault, at the hearing. "To us, the only reasons to have a NDA are if they're going to tell you something that otherwise they wouldn't want people to know," said DeVault, suggesting the potential of them selling data downstream or intellectual property conflicts. "That lack of transparency didn't sit well with us," he said. But the company hardly considers that a loss. Epic's Care Everywhere interoperability network has 100,000 physicians live on it. CommonWell Health Alliance, according to the most recent report DeVault had seen, only had five participating organizations and 1,000 physicians. Apples and oranges. 
Epic got grilled. 
Senators Bill Cassidy, R-La., specifically, had hard questions for Epic's DeVault.
"We are looking at cost. Y'all have 50 percent market share," said Cassidy. "That looks at you," he said, referring to the EHR giant. Cassidy pressed DeVault for answers about how much Epic charges for sending patient data elsewhere on a per patient basis. 
The low number seemed to surprise Cassidy. "$2.35," said DeVault. And that's the cost to the customer whether the patient data is sent to a hundred different places or one other place. What's more Epic doesn't charge for upgrades like other vendors, as DeVault pointed out. (Wergin's vendor does.)