Senior officials in the healthcare sector took aim at the tech companies that provide electronic health records (EHR) yesterday, saying that many of those vendors employ proprietary standards and deceptive strategies to lock providers into their products and keep systems from communicating with one another.
Interoperability has long been a core challenge in promoting the adoption and use of EHRs, and that issue dominated the latest in a series of hearings the Senate Health, Employment, Labor and Pensions Committee has been holding on health IT.
"Information blocking is one obstacle to interoperability," says Lamar Alexander (R-Tenn.), chairman of the HELP Committee.
Alexander says that he and the ranking Democrat on the panel, Patty Murray, met with Health and Human Services Secretary Sylvia Mathews Burwell before Thursday's hearing, and suggests the government hold off on issuing any new mandates on EHRs to allow the industry catch up to the current iteration of the meaningful use standard for Medicare reimbursements.
"My instinct is to say to Secretary Burwell, let's not go backwards on electronic healthcare records, but let's not impose on physicians and hospitals a system that doesn't work and which they spend most of their time dreading," Alexander adds. "Half the doctors are now paying penalties rather than participate in electronic medical records. We want something that physicians and hospitals buy into to help patients rather than something that they dread."
Witnesses at the hearing generally agreed that postponing the deadline for stage three of meaningful use would be a relief to the industry, but they saved most of their ire for the EHR vendors.
Data blocking by vendors remains biggest frustration
"The biggest challenge we face is liberating patient data from EHR systems to make it interoperable," says David Kendrick, chair of the Department of Medical Informatics at the University of Oklahoma and the CEO of MyHealth Access Network. "While many EHR vendors work well with their customers and with our organization to establish interoperability, we still have so many specific experiences with inappropriate data blocking and substandard data quality that we've created a nomenclature to classify" different patterns of information blocking.
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Kendrick cited the fees that some vendors charge to make data in their EHR systems fluid, while others don't code entries properly so deduplication becomes impossible, rendering the dataset effectively useless. Some vendors engage in what he called a "bait and hidden switch," where a product achieves certification, but the portability features are stripped away when the system is deployed in the field.
Still others circumvent the portability component of EHR certification to create what Kendrick calls a "Hotel California" problem -- "they can check out other EHR products any time they like, but their data can never leave."
Kendrick is calling on the Office of the National Coordinator (ONC) for Health IT to step up its oversight of the EHR market to help weed out bad actors that unfairly block the movement of health information.
Paul Black, president and CEO of AllScripts, offers a tepid defense of the EHR community, observing that while the "the current narrative on interoperability is often negative," there are plenty of examples of systems talking to each other and smoothly relaying data.
He urges a light-touch approach from Congress and the ONC, appealing to allow the standards in place to take hold before imposing new ones. He envisions that interoperability will improve as payments begin to incentivize data mobility in EHRs.
"It is true that not all stakeholders seem to be equally motivated to make information liquid, and sluggish exchange largely stems from one massive gap -- the lack of a strong business case for interoperability in healthcare," Black says. "A payment system that has been in place for decades does not motivate them to create an interconnected healthcare environment."
Murray acknowledges that the sensitive nature of the data stored in EHRs might make companies reluctant to easily share data, but she points to a recent ONC report that identified numerous instances of deliberate information blocking, an issue she and Alexander are working to address in legislation they are currently developing.
"It's important to make clear there are some legitimate reasons that a vendor might limit the exchange of health information -- patient privacy, or unanticipated technological challenges," Murray says. However, "there's substantial evidence that some organizations are intentionally setting up barriers between their systems and other systems, or overcharging, or creating technical or legal barriers to providers who want to access information through the system they purchase -- or both of those. To me, these efforts to knowingly interfere with access to patients' health information is completely unacceptable."