Achieving health IT interoperability, the seamless ability to share and utilize patient data among different Electronic Health Record (EHR) systems has long been an issue within healthcare. Complex healthcare systems require diverse EHRs and achieving interoperability can alleviate many complications. Interoperability augments EHR systems by enabling better workflows, reducing ambiguity, and allowing seamless data transfer among other systems and healthcare stakeholders. Ultimately, an inoperable environment improves the delivery of healthcare by making the right data available at the right time to the right people (HealthIT.gov). Despite the advantages of interoperability, few EHR vendors have dedicated the time and resources to achieve meaningful standards. With such advantages recognized by all parties throughout the entire healthcare industry, this leaves one to question why?
According to Miriam Reisman, author of EHRs: The Challenge of Making Electronic Data Usable and Interoperable, an estimated 63% of physicians were still using fax machines as a primary means of communication as recently as 2012. Although this figure may seem misleading, multiple factors continue to deter interoperability to this day. Reisman states
“hundreds of government-certified EHR products are in use across the country, each with different clinical terminologies, technical specifications, and functional capabilities. These differences make it difficult to create one standard interoperability format for sharing data” (Reisman).
Furthermore, healthcare organizations often acquire products from more than one EHR vendor and are specifically designed to meet that institution’s unique standards and needs. In turn, this makes interoperability within one organization exceedingly difficult, let alone on a universal scale.
Brian Lancaster, Nebraska Medicine Vice President of IT believes the current state of EHR design is a major problem for health data exchange and argues,
“if a project requires two different systems to talk to each other, they may not be interoperable. The problem is, each of these systems have so many configurations. It’s a quagmire. There’s huge pressure for the EHR to get the data sets right and all the complex workflows right, which is difficult. Can it be made easy? I don’t know” (O’Dowd).
Lancaster’s question reveals another obstacle to interoperability; not a technical obstacle but a cultural one. In order to achieve healthcare interoperability, a collaboration of essential “stakeholders including patients, providers, software vendors, legislators, and Health IT professionals” is necessary (Reisman 573). Collaboration from varying parties who disagree on interoperability standards, put their best interests first, and intentionally block patient information results in incessant challenges.
A Hopeful Path
Achieving EHR interoperability is a daunting yet not impossible task. Similar to incentivizing EHR adoption under MU, MACRA, and HITECH, the path to interoperability may occur if strong incentives promote it. Although interoperability or, ‘health information exchange’, was specified as a required capability of certified EHRs, it was delayed to Stage 2 of the MU program. In turn, EHR vendors subsequently shifted focus away from this functionality and are still catching up (Adler-Milstein). Indeed,
“weak regulatory incentives pushing interoperability, even in combination with additional federal and state policy efforts supporting HIE progress, could not offset market incentives slowing it. Without strong incentives that would have created market demand for robust interoperability from the start, we must now retrofit interoperability” (Adler-Milstein).
Reisman similarly argues “the government will need to provide stronger incentives to both providers and EHR vendors to promote interoperability” (Reisman). Incentives however, will not single handedly pave the way to full-fledged interoperability. Advancing sophisticated technologies and proper infrastructure such as Application Programming Interfaces (APIs) are also necessary. APIs are interfaces that promote interoperability among disparate health IT systems by enabling unrelated software programs to communicate and interpret data. APIs act as a bridge between two applications, allowing data to flow regardless of how the applications were originally designed (O’Dowd). APIs are an effective tool and receive ubiquitous support from healthcare organizations and government agencies such as the Centers for Medicare & Medicaid Services (CMS). Achieving universal interoperability will be a long and arduous journey dependent on cooperation from varying stakeholders. Among other objectives, the government must promote stronger incentives, health IT vendors must end information blocking, and healthcare organizations must adopt proper IT infrastructure technologies such as APIs.
Tapuria, Archana; Kalra, Dipak; Kobayashi, Shinji (2013). “Contribution of Clinical Archetypes, and the Challenges, Towards Achieving Semantic Interoperability for EHRs.” Healthcare Informatics Research, Vol. 19, No. 4.