EHR Business Environment Must Change to Achieve Interoperability

The main challenges for the nation’s health IT interoperability are not technical but business related.

That’s the word from former National Coordinators for Health IT speaking in a panel session on Tuesday at ONC’s Annual Meeting in Washington.

Farzad Mostashari, M.D., former National Coordinator for HIT and currently CEO of start-up Aledade which partners with independent primary care physicians, warned that business practices among some electronic health records vendors are inhibiting the sharing of health information by restricting information exchange with users of other EHR products.

“My practices—I’m working with small practices—can’t get their own data out and it’s not because of the technical standards. It’s because of the business practices,” said Mostashari. “I think it’s fantastic to create a value-based payment environment where the providers are incentivized to be able to use that clinical data that we’re now collecting and to take it out and have third party applications do analytics and all this great stuff. But, the vendors don’t have the same incentives as the providers do.”

Mostashari described the current EHR vendor business environment as a “market failure” given that these companies don’t reflect the desires of their customers. “It’s better for the vendors, frankly, if they get paid for every interface,” he asserted. “Standards were going to reduce the cost of interfacing. Will they reduce the price is another question. I still have my practices paying $10,000 for a C-CDA interface.”

David Blumenthal, M.D., former National Coordinator for HIT and currently president of The Commonwealth Fund, similarly argued that interoperability is a “human ware problem as much as a software problem.” If there was a strong will among EHR vendors to exchange information, Blumenthal said “we would find a way to do it with current infrastructure and technology capabilities, but there is no business case for the vendor and there hasn’t been one for the provider.”

He believes that “it is much easier to solve technology problems than it is to confront the fundamental characteristics of the healthcare market” in the United States. “We can have the most beautiful technological solution,” Blumenthal opines, “but humans will find a way not to implement them if it’s not in their self-interest.”

Blumenthal describes the marketplace dynamics as a cognitive dissonance: “We want our markets to be fiercely competitive. We want people to cut each other’s throats for market share. And, then, we want to say ‘stop’ and blow a whistle and say ‘now be good friends and neighbors and share your most valuable proprietary data and pay to do it.’”     

Last March, industry stakeholders at a Federal Trade Commission workshop on healthcare competition warned that the proliferation of closed data networks are trapping providers and patients into proprietary networks that are barriers to interoperability. Specifically, they charged that some health systems block patient information sharing in ways that have antitrust implications.

For its part, ONC has publicly pledged to work more closely with FTC to formulate policies that “improve transparency, promote interoperability, create incentives for quality, and reduce barriers to competition and innovation.”