Why interoperability needs more cooperation, less blaming

HHS Secretary Sylvia Burwell’s February announcement of the interoperability initiative was a big step forward. Four months later, are cracks beginning to show?

Interoperability—let the finger-pointing begin.

In recent weeks, the trek toward the seamless exchange of healthcare information has become much steeper, more challenging, perhaps even a bit messier.

This comes only four months after the prospects for interoperability looked much more promising. That was way back at the HIMSS annual conference, when, on February 28, HHS Secretary Sylvia Burwell outlined the organizations, vendors and professional associations that declared to commit to three simple objectives in information sharing.

At that event, HHS reported that it had cobbled together commitments from about 15 major EHR vendors, 16 healthcare provider organizations and 16 of the nation’s largest and most influential provider, technology and consumer organizations.

Ah, those HIMSS romances—so fleeting. Apparently, what’s announced in Las Vegas stays in Las Vegas.

Despite the warm fuzzies ensuing from the announcement earlier this year, most in the industry know that achieving interoperability is going to be a long, difficult journey. The big news, it seemed then, was that so many prominent players in the industry seemed aligned on the goal.

Given the passage of time, however, segments of the industry seem to be falling back into fortified positions.

In early June, the American Medical Association and 36 other societies told federal officials that existing metrics for assessing the extent of health data interoperability, grounded in electronic health records’ meaningful use criteria, are insufficient and should be replaced.

“Despite claims by many health IT vendors that their products are interoperable, the vast majority only exchange static documents in a manner that satisfies minimum meaningful use requirements,” the organizations said in letters to the Centers for Medicare and Medicaid Services and Office of the National Coordinator for Health Information Technology. “Many in healthcare view this level of exchange as little more than digital faxing.”

“The lack of interoperability is one of the major reasons why the promise of electronic health records has not been fulfilled,” said AMA President Steven J. Stack, MD. “Vendors have been incentivized to meet the flawed benchmarks under the Meaningful Use program. We need to replace those benchmarks with ones that focus on better coordinated care.”

That line of reasoning continued at the AMA’s annual meeting in Chicago in mid-June, when none other than CMS Acting Administrator Andy Slavitt placed the onus on vendors to deliver on the promise of health IT, singling out making progress on interoperability.

Slavitt said CMS has heard the calls for “putting more pressure on technology vendors” and less on physicians. In his comments, Slavitt argued that interoperable health information would enable physicians to do tasks as simple as tracking referrals when a patient sees another specialist or visits a hospital—capabilities that don’t exist today, he contends.

The comments drew an immediate response from Leigh Burchell, chair of the EHR Association (EHRA) and vice president of government affairs at Allscripts, who said “Interoperability is a critical area of focus for us all...no one stakeholder can resolve all the issues that stand between where we are today and where we want to be in the secure sharing of patient information across provider organizations—issues such as HIE governance, data ownership and privacy agreements, and a consistent patient identity approach across disparate systems.”

Now, with comments out on the notice of proposed rule making for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), there’s still some residual chippy comments on the topic of interoperability.

In its comments on the proposed rule, EHRA called for more regulatory guidance and additional clarity on what attestation means, and said it believes that some portions of the data-blocking attestations being asked of providers go beyond what Congress intended or authorized, and thus shouldn’t be retained. To be fair, EHRA said it made those comments because it believes the requirements will impose significant cost and uncertainty on providers.

However, it also believes that “data blocking and interoperability attestations go beyond the requirements of MACRA and what should be expected via provider attestation. We do want to emphasize the very strong support of the Association for interoperability and opposition to true data blocking. We do not think that this proposal is the appropriate approach to advance these priorities and that it will impose costs that far exceed any benefits.”

To be fair, some terrific progress has been made in recent months on interoperability, and prospects for data exchange have never appeared brighter.

And also, it’s certainly true that an industry-wide initiative of this importance and complexity will require accountability, and segments of the industry will need to bear their responsibility and be called out if they are standing in the way of interoperability. As developers of HIT systems, vendors certainly bear a heavy responsibility in the effort.

But achieving the type of interoperability the industry needs will require all participants to work together, work together closely and become true partners in achieving the whole goal.

What was announced at HIMSS as the three goals—consumer access to their electronic health information, no information blocking and the use of standards—are just the beginning baby steps of what’s needed. Baby steps are always significant, but they are only the first toward the foundation of what’s needed—to get information flowing, getting it to the right person, at the right point of the workflow, with the identity of the patient locked down and solid, with everyone understanding the same meaning from the terminology.

There are years of work ahead of the industry, and those who pledged to work together in February will need to be partners for the long haul. As the old saying goes, “When I point one finger at you, I point three back at myself.” Solving interoperability, as it needs to be solved, will require everyone to bear their own responsibility.

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