The federal government’s Meaningful Use program is hindering, not helping, private sector efforts aimed at enabling nationwide electronic health record interoperability.
That’s the finding of a new Government Accountability Office report based on a survey of 18 non-federal initiatives seeking to achieve EHR interoperability. Officials in those initiatives argue that changes to the Meaningful Use program would help move nationwide interoperability forward.
Representatives from 10 of the initiatives indicated to GAO that Meaningful Use requirements “divert resources and attention from other efforts to enable interoperability.” For example, some initiative representatives say that the program’s criteria require vendors to incorporate messaging capabilities into EHR systems, but this capability generally does not enable interoperability at this time.
In addition, representatives from 10 of the initiatives told auditors that the criteria currently used to certify EHR systems under the Medicare and Medicaid EHR Incentive Programs are “not sufficient for achieving interoperability.” Three of these representatives suggested “amending the criteria” to focus on the ability of testing systems to interoperate.
“While 8 initiative representatives we spoke with told us that the EHR Incentive Programs have increased adoption of EHRs, representatives from 5 initiatives suggested pausing or stopping the programs,” states the report.
GAO conducted the study at the request of Senate Health Committee chairman Lamar Alexander (R-Tenn.), Senate Commerce Committee chairman John Thune (R-S.D.), Senate Agriculture Committee chairman Pat Roberts (R-Kan.), Senate Intelligence Committee chairman Richard Burr (R-N.C.), and Senate Budget Committee chairman Mike Enzi (R-Wyo.).
“Since 2009, the federal government has spent more than $30 billion to encourage the nearly 500,000 physicians and more than 5,000 hospitals who serve Medicare and Medicaid recipients to establish electronic health records systems through the Meaningful Use incentive program,” said the five senators in a written statement. “One of the chief goals of this effort was to improve the electronic exchange of a patient’s health information between physicians’ offices and urgent care centers and hospitals and pharmacies—by both encouraging these practitioners to adopt these systems through the Meaningful Use program, and by encouraging manufacturers of the systems to make them able to communicate with one another.”
However, the senators charge that the Meaningful Use program is “actually slowing down data sharing between doctors and hospitals,” citing the fact that the majority of representatives from the non-federal initiatives surveyed by GAO say that the program’s requirements “take time away” from achieving EHR interoperability.
GAO was specifically asked by the senators to review the status of efforts by entities other than the federal government to develop infrastructure that could lead to the nationwide interoperability of health information.
“Although the federal government plays a key role in guiding movement toward interoperability, many of the actions are to be completed by non-federal stakeholders,” noted GAO. These non-federal initiatives include: creating guidance related to health data standards, encouraging the adoption of certain health data standards or policies that facilitate interoperability, and operating networks that connect EHR systems to enable interoperability.
Works in Progress
GAO surveyed 18 non-federal initiatives to achieve EHR interoperability—such as the Argonaut Project and CommonWell Health Alliance—finding that most of the initiatives remain “works in progress” with the majority still in the process of developing or encouraging others to adopt their products and services.
For its part, the Argonaut Project recently entered Phase Two of its efforts to accelerate development and adoption of Health Level Seven International’s Fast Healthcare Interoperability Resources (FHIR), an interoperability framework leveraging the latest web standards including a RESTful application programming interface (API)—an approach based on modern Internet conventions widely used in other industries.
Last week, HL7 announced that it had published Release 2 of the FHIR Draft Standard for Trial Use (DSTU 2), the culmination of 18 months of work. While the FHIR specification is still a draft standard for trial use, Micky Tripathi, Argonaut Project manager and president/CEO of the Massachusetts eHealth Collaborative, says that providers and vendors participating in the project are “on the same page now” as they continue the active testing phase of the program.
“The next step will be the final, normative standard,” according to Tripathi, who says the publication of that specification is targeted for 2017 based on the current timeline.
Jitin Asnaani, CommonWell’s executive director, believes it’s an important time to be working in health IT and all of these initiatives present unique possibilities for the future of interoperability.
“Speaking for CommonWell, we’re excited about the progress we’ve made in our first couple of years,” says Asnaani. “With our membership growing from 5 in 2013 to 33 today and our national expansion of services announced less than a year ago, we are seeing great momentum, with providers adopting CommonWell service through our members across the continuum of care. We are well on track with having 5,000 providers live on CommonWell services by the end of the year.”
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