Congress approved today a $6.3 Billion (with a B) “Medical Innovation’ package that does a whole lot of things, including the focus of this post, provide penalties for “lack of interoperability” in EHR systems.
As consumers of EHR systems, providers have long complained about the absence of a common language or interface between systems. It’s possible to build said “interfaces” between disparate systems, although most frequently those are between a data gathering tool like an XRAY/PACS system or third party Laboratory providing results of one sort or another to a physician or physician office. Less frequently, and far less successfully, EHR systems are able to exchange complete patient health information. This legislation at least paves the way for true interoperability.
How will they do it? Are we going to see a standardized medical language library? What about exchanging the mountains of “results” that already exist in patient files?
Jane Doe presents at her primary care physicians office complaining of shortness of breath. Her primary care doc runs some tests, maybe some blood work, and sends her to an imaging center down the road for a chest XRAY. The labs come back vie an electronic interface. The XRAY comes back on CD, but he does not have a PACS system in his office, so he simply views them, but does not import into her chart. How does he record the results of the chest XRAY beyond a “positive” in this hypothetical? Lets say that he believes she has pneumonia, and sends her home with a prescription for rest and an antibiotic.
Two days later she is worse and presents to the Emergency Department at her nearest hospital. They don’t have time to request records, if they were even aware they existed. They don’t have time to request, receive and review the XRAY CD, even if she had brought it with her (she didn’t). They must, at significant cost to the patient and/or insurance company, re-do all her tests.
In this story, we like happy endings, and we find that she simply had some swelling in her bronchial airways, and adding a steroid to her prescription solved the problem and she went back to work in a few days.
But it might have gone differently. It might have been a terrible story of a missed diagnoses, and she might have died.
Neither outcome is good. Fully 20% of our GDP is spent on healthcare! There are many reasons, but partly because of stupid systems like this. There is simply no reason to perform tests over and over again, but doctors and hospitals are incentivized to do it. They both get paid.
If the data lived in ONE place, an HIE, or Health Information Exchange, and the different systems all accessed and wrote to the same centralized record, that the patient had ownership of, instead of having two or three or even ten different records, in different formats, at different offices, it would be much more difficult to justify running a $400 XRAY study. It would provide near instant access to up to date records, up to the minute records, to any physician involved in a patients care. Forced interoperability removes the first barrier to this happening.
But here’s an unintended consequence. If every vendor out there today is going to be forced to provide interoperability, to be able to share data with disparate systems in a standardized format, guess what else happens?
Bad systems are eliminated! If my ten year old EHR that has been dragging it’s feet into compliance, scraping by, only making the minimum effort to be certified, faces the challenge of updating and providing interoperability or losing certification and facing fiscal repercussions, they have only one choice to make. Do they come forward? Or not? And if they do, they absolutely MUST improve the product. They will have to heed every complaint from every customer and make an effort, or those customers, with their new found interoperability, will take those records to an EHR platform that WORKS. Now we have a situation where the best designed, best performing platforms will truly excel because they are the best.
Could it be that Congress just passed a law that could, just maybe, be encouraging a true Free Market where the best product can be the best and has a chance to out perform the others? Don’t tell them. They’ll find a way to fix it.