According to the Healthcare Information and Management Systems Society (HIMSS), interoperability refers to the capability of devices and systems to communicate and understand data. Over the last decade, the majority of healthcare facilities have adopted systems of electronic health records (EHR) at a total estimated cost of $27 billion, which house clinical patient data.
One problem is that the various types of electronic record systems are often incompatible, or unable to communicate and interpret the data from one another. This can be a problem as a patient moves throughout the healthcare continuum such as from their primary care physician, a specialist, a hospital etc. Brian Lancaster of Nebraska Medicine says the lack of standardization is a significant challenge to organizations as they are often unable to exchange records.
Interoperability Initially Overlooked
A federal mandate required providers to implement EHR's by 2014 and included significant financial incentives. The 2009 Health Information Technology for Economic and Clinical Health (HITECH) program sought to be sure that the systems had some of the same capabilities. Within the legislation there were certification requirements specifying the ability for “health information exchange”. Gradually, amid EHR implementations across the country, the concept of compatibility diminished. The market did not truly incentivize interoperability and some vendors figured it was easier to retain their customers if transferring the data was difficult.
Researcher Julia Adler-Milstein, a PhD from the University of Michigan, explained what should have occurred. If interoperability had been effectively incentivized or required, it is likely that the majority of systems would be compatible today. Policymakers could have certified a small group of vendors, which would have limited the widespread interoperability problems. Many suggested simply mandating a single style or format; however, this obviously would have run contrary to our market-driven economic beliefs. Vendors simply did not make interoperability a priority, as it did not provide them clear economic benefits.
In our current regulatory climate, medical providers are increasingly challenged to meet requirements. This is increasingly difficult with the amount of patient data that is accumulating. Requirements involving documentation and reporting are becoming necessary to secure reimbursement. Many practices that are smaller in size, or those found in rural communities, lack the economic resources for solving these technical challenges. Instead, they are often left to manually attempt to interpret data presented in a disorganized format that will inevitably lead to mistakes and the potential for medical liability.
Tom Skelton, CEO of Surescripts, summarized the problem as a “fragmented environment in need of an easy way to exchange information”. Reaching a point of universal interoperability will be challenging. The industry needs to define some uniform standard of formatting data. Some encouraging signs recently have included the increased acceptance of standardized terminology such as in FHIR and CDA. Vendors must have a financial reason to promote interoperability. At some point, patients should be able to securely transfer their medical records to a small device for simple transfer to other medical providers.