WASHINGTON -- The great promise of electronic health records (EHR) and health information exchanges -- that patients' health information can pass seamlessly among providers, vendors and health care systems -- will never be realized until those systems run on a set of common standards and achieve a greater level of interoperability.
That was one of the messages that scores of health IT advocates from around the country took to Capitol Hill last week as they met with lawmakers from their home states to press for congressional action on an array of issues concerning the use of technology in health care.
"If you think about it, interoperability and health information exchanges are fundamental to health reform," John Loonsk, the chief medical information officer with CGI's federal division, said at a policy conference coordinated around the Capitol Hill fly-in, organized by the Healthcare Information and Management Systems Society, a not-for-profit group that works to advance health IT initiatives.
Health IT Advocates Three 'Asks'
The push for greater interoperability around EHR systems was one of three "asks" the health IT advocates lobbied for in their meetings with lawmakers and staffers. They are also prevailing on members to champion a nationwide strategy for identifying patients and accurately matching them to their EHRs, citing industry estimates that between 8 percent and 14 percent of medical records contain faulty information that results from misidentifying the patient.
--Bryan Sivak, CTO of Department of Health and Human Services
Additionally, they are seeking congressional action to bring the quality reporting requirements associated with the federal EHR incentive program in line with those of other health IT compliance efforts in bid to move toward a nationally understood definition of clinical quality measures.
Each "ask" comes in response to the rapid and fragmented development of health IT systems, a fast-growing market that got a shot in the arm with the passage of the Health Information Technology for Economic and Clinical Health -- HITECH -- Act of 2009, a provision of the omnibus economic recovery bill that created incentives for the adoption of EHRs and other health IT initiatives.
In the time since, the use of EHRs has "reached a tipping point," according to Kathleen Sebelius, secretary of the Department of Health and Human Services, which is overseeing implementation of the HITECH Act. In May, HHS announced that it had reached its goal of seeing EHRs deployed in 50 percent of doctor offices and 80 percent of eligible hospitals by the end of the year.
But putting EHRs in place is only the beginning of the story, and too often a lack of interoperability means that those systems operate in siloes, amounting to little more than a digitized version of paper records, Bryan Sivak, the CTO of HHS, said at last week's conference.
Humans Offer the Greatest Challenge
But Sivak argued that standards will only take the industry so far, suggesting that winning over providers, administrators and other healthcare workers to the new systems might be a greater challenge.
"The tide is starting to turn, but these systems, you know, they don't talk to each other on a regular basis, right. We don't exchange information. We don't leverage the data that we have in as useful a way as we can. Personally, I think part of the solution is technological, but I actually think the technology part is the easy part, because we can craft standards and we can get people to agree on standards. I think the harder thing is cultural. I think the harder thing is getting people to think about doing their jobs that they've been used to doing for many, many years in a different way, and using different inputs than they typically do to actually change things. I think that's the critical factor that we have to think about is how do change the culture of some of this stuff. How do we embrace this idea of information availability? How do we insist that data and information become one, and become part of the practice and become part of the job that we're all here to do?"
The health IT advocates who fanned out across Capitol Hill were not asking for specific legislation to address the interoperability issue. Rather, they were lobbying members of Congress to use their oversight authority to encourage the development and implementation of consistent definitions and technical standards to ensure interoperable systems, particularly as HHS rolls out the next phase of its meaningful use program, the EHR eligibility criteria for Medicare and Medicaid discounts.
More than 900 systems have already received certification in the first stage of meaningful use, but Loonsk warns that the interoperability challenges, already evident in the market, will be only further complicated as HHS moves ahead with stage two.
"The importance of being able to connect with them, communicate with all of those, puts a real fine point on the needs of interoperability, and there's a lot out ahead of us in that regard," he said. "To do all that, we need a common language. We need a common language of standards. We need a common language of support tools that support interoperability as well."
Skeptics of the standards movement have noted that the health IT sector does not suffer from a lack of standards -- indeed, it is inundated by them. So how, then, would adding more standards help simplify what is already a forbiddingly complex market?
"In many respects that's true, but what there is not a lot of is the specific guidance -- geek term: implementation guidance -- that defines exactly how to use those standards and how to use them well," Loonsk said.
"The other aspect of this is that that guidance is really needed early in the process," he added. "So it's not needed the day before a regulation goes into effect. It's needed well out in front of the process when software is being developed so that the developers can build it into their products and use those standards, use that implementation guidance to make their systems compliant."
Kenneth Corbin is a Washington, D.C.-based writer who covers government and regulatory issues for CIO.com. Follow Kenneth on Twitter @kecorb. Follow everything from CIO.com on Twitter @CIOonline, Facebook, Google + and LinkedIn.