Why government interoperability mandates hurt patients and providers
Many Americans have never heard the term “interoperability,” but the U.S. government has been pushing it as a healthcare reform goal for a while.
While this effort may be well-intentioned, the Department of Health and Human Services’ current activities to achieve interoperability are putting patients’ lives and privacy in jeopardy, and exposing healthcare providers to intolerable levels of risk.
The National Coordinator for Health Information Technology developed a detailed roadmap to define the concept of interoperability and set goals. But simply put, interoperability is the idea that patients and providers nationwide should have seamless access to health information from a variety of sources, including electronic health records at all points of care.
That’s a worthy objective. It can improve care coordination, reduce costly duplicate tests, allow patients to take a more active role in their care, and enable public health agencies and researchers to gain insight into population health trends. For these reasons, the government has spent tens of billions of dollars in incentive payments to encourage clinicians to adopt EHRs and then use them in such a way so as to demonstrate meaningful use.
But the problem is that there’s no reliable way to identify patients across the care continuum. What’s needed is a National Patient Identifier (NPI) system, which would promote interoperability goals without sacrificing other healthcare objectives, including care quality, savings, patient privacy protections guaranteed by HIPAA and a fair shake for clinicians who are now drowning in regulatory red ink.
Years ago, to protect patients from identity theft, the government enacted legislation to prevent healthcare providers from using Social Security numbers as identifiers. Currently, there are laws on the books preventing the establishment of an NPI system. But demanding interoperability without putting an NPI system in place is like starting the Social Security program without issuing Social Security numbers.
Vendors of EHRs and other clinical information systems, as well as industry associations, have repeatedly advised HHS and other government agencies to adopt an NPI program. We’ve spent millions on certifications to enable physicians, dentists, chiropractors and eyecare professionals to participate in EHR programs, but without an NPI system, interoperability is a hindrance to achieving benefits on these investments instead of a benefit.
Congress has considered removing legal barriers and establishing an NPI program for years, but to date, the politicians have been all talk and no action. Yet the march toward interoperability continues. This is dangerous, because it creates a system that is hyper-connected without adequate security. Cybercriminals are poised to bankrupt citizens via identity theft and flood programs and insurers with fraudulent claims.
In the current healthcare reform debate, President Trump said identifying waste and abuse in the system is a primary goal. Tens of millions of dollars could be saved by redirecting funds currently used to enforce unrealistic interoperability standards toward an NPI program. Millions more might be recoverable from providers who received EHR incentive funds without following through on meaningful use pledges.
The status quo is intolerable because it degrades our entire healthcare system. Patients are rightly concerned about medical errors; a recent survey found that 80 percent of hospital employees knew of instances where patients were harmed as a result of treatment mismatches. Interoperability achieved through NPI could reduce these types of mistakes, but without NPI, interoperability multiplies the dangers while exposing records to theft.
EHR vendors estimate that in the current environment, with the very best hospital, staff and protocols in place, the risk of mismatching patient information is reduced to 10 percent to 20 percent of all cases. That’s unacceptable. Interoperability is a worthy goal, but it’s not worth asking patients and their family members to accept an alarmingly high risk of being harmed or killed because of a records mismatch.
The problems caused by the lack of an NPI program are serious enough that several organizations have formed to address them. Membership tends to be expensive. But none have access to all data for all patients in the U.S., and it’s unlikely that they ever will. Even if it were possible for a single organization to handle the data, it would be controversial (to say the least) to privatize such a function.
The bottom line is this: our government’s current stance places undue emphasis on interoperability at the expense of patient safety, and that must end. HHS should stop pressuring healthcare providers to improve connectivity without the security of an NPI program. By establishing an NPI system and then moving toward interoperability, HHS could better achieve its stated goals of saving money, improving care and upholding HIPAA privacy rights.