It has been 12 years since Rand Corporation published a study in Health Affairs extolling the values of a wide adoption of Electronic Health Records (EHR). However, 12 years after the fact, the IT industry has seemingly missed the main point.
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In the opening section, it addresses the potential savings, costs and safety benefits. In the sentence that follows, they define what is meant by the word potential, “assuming interconnected and interoperable EMR systems are adopted widely and used effectively.” In the concluding section, it states, “also, even if EMR systems were widely adopted, the market might fail to develop interoperability and robust information exchange networks.”
Obviously, in the study, interoperability was an important and probably the main driver of cost savings. So where are the IT vendors on interoperability? The answer is probably close to nowhere.
In a recent study that appeared in March of 2017, investigators at the University of Michigan conducted a survey of Health Information Exchanges (HIE) nationwide that addressed their experience with information blocking. Fifty percent of respondents reported that EHR vendors routinely engaged in information blocking and 33% reported that EHR vendors occasionally engaged in information blocking.
For hospitals and healthcare systems, 25% were reported to routinely engage in information blocking and 34% were reported to occasionally engage in information blocking. When the survey asked about the form of information blocking used by EHR vendors, 49% reported products with limited interoperability and 47% reported that vendors routinely or often charged high fees for health information exchange unrelated to cost.
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Obviously, the EHR vendors appear to be the main source of information blocking and limited interoperability is the most cited method. I would draw your attention to the statement by the Certification Commission for Health Information Technology (CCHIT) which listed the criteria that would take effect on July 1, 2009, for Certification of Ambulatory EHRs. It lists three areas, functionality, interoperability, and security. Under interoperability it states: “the ability to receive and send electronic data between an EHR and outside sources of information such as labs, pharmacies and other EHRs in physicians’ offices and hospitals.” This appeared sometime prior to July 1, 2009. The University of Michigan study above appeared in March 2017. That would be at least 7 years, 8 months after the CCHIT requirements for interoperability were set to take effect.