Interoperability is expected be a key focus for EHR systems and the physicians who use them in 2016. We asked Micky Tripathi, founding president and CEO of the Massachusetts eHealth Collaborative, about the latest important developments on EHR interoperability and how they may impact your practice.
MMS: Tell us what the recent “KLAS” agreement means for physicians?
MT: The recent summit meeting (hosted by KLAS, the independent health information technology review organization) was a unique private sector initiative to establish objective “Consumer Reports” style measurements of interoperability performance across EHR systems. The summit brought together 10 major EHR vendors as well as 30 large provider organizations from the around the country. Over an intensive two days, the group achieved consensus on a measurement approach and process to be conducted by a credible, neutral organization. The measurement process will be the first comprehensive measurement of nationwide interoperability capturing both provider and vendor attributes. In other industries, the private sector comes together to hold itself accountable by working collaboratively on transparent measures of progress. The KLAS agreement represents a significant step forward in the maturity of the health IT industry.
MMS: How will we know when interoperability is working?
MT: When people stop complaining about it! Just joking. Interoperability isn’t a single thing – it’s a general term that describes different types of information exchange appropriate to a particular purpose. For example, email is very good for certain types of communication, but is a very poor substitute for those times when only a phone call will suffice. Similarly, sometimes a provider wants to have a complete medical summary sent to them, in which case they would want to receive a continuity-of-care document, whereas at other times they may just want to check on a medication allergy, in which case a “magic button” single-sign on viewer would be most important. Both types of exchange are important, each is appropriate to the specific clinical need.
Interoperability is already working very well in some areas — as (the science fiction author) William Gibson reportedly said, “the future is already here, it’s just not very evenly distributed.” Take electronic prescribing, for example — a huge success across the country. Similarly, lab results delivery is very widely available in most health care delivery areas across the country. EHR-to-EHR exchange has been harder to accomplish because it relies on coordination of many different vendors as well as many different providers. Even here we’re seeing tremendous progress though. The Massachusetts Health Information Highway has over 500 provider organizations connected and conducts over 2 million secure health information exchange transactions per month.
However, interoperability will never be “done.” As information technology gets better and medical advances continue, our expectations will grow as well. We’ve seen with computers and smart phones that the more they do, the more we want. The same is true for interoperability as well.
MMS: What timeline do you expect in terms of seeing widespread improvements in interoperability?
MT: We’re already seeing them. It’s important for us to have some perspective though. Just like you can’t have a good telephone network until most people have a telephone, you can’t have good interoperability until most providers have an EHR. A short 5 years ago, less than 10% of physicians had an EHR. That number is now over 75%, and for hospitals it is now over 90%. So, why do we think that we should have universal interoperability already, when just a couple of years ago most physicians didn’t even have an EHR? No other industry has achieved it that fast, and yet, no other industry is as complex as health care.
The biggest barrier to interoperability until now has been lack of demand — physicians weren’t asking for interoperability because they didn’t have EHRs and because prevailing models of care and payment didn’t require interoperability. The world is different now, and physicians are demanding interoperability from each other and from their vendors, and we’re seeing the market respond. Within the next few years I think we’ll see close to nationwide ability to send clinical documents to any provider in the country, and we’ll see the maturation of nationwide health information networks that also enable query and retrieve capabilities as well.
These networks are already emerging rapidly – like Epic’s Care Everywhere, Surescripts, CommonWell, the MA HIway, etc – and in the next few years we’ll see the building of “bridges” across these networks in the same way that phone networks and ATM networks are stitched together to provide universal coverage.
MMS: Do you think some regulation or a government mandate is inevitable down the road?
MT: I hope not. It would be a terrible mistake, and I guarantee that most physicians will be very unhappy with any kind of government mandate for interoperability, whether at the state or federal level. Health care and IT are too complex to expect that the government can get it right or keep up with it. The best prescription for getting more interoperability is to expand value-based purchasing through Medicare and Medicaid that pays for better care and improved outcomes. That will create more demand for interoperability but will allow providers and their vendors to come up with the best ways to accomplish it.
— Erica Noonan