Government regulations have changed the healthcare landscape in recent history. The introduction of EHRs has had a profound effect on doctors and patients, good and bad. Due to regulation, security concerns, and a conservative IT approach in healthcare, the market been dominated by a few big EHR companies, and they are fighting to keep their share. This has led to information blocking and hospital systems that can't even share data within their network. There has been little incentive for the EHR companies to deliver interoperability, but now the Office of the National Coordinator for Health Information Technology has proposed compliance requirements that will make it mandatory. How will this affect healthcare technology?

When the US EHR initiative was launched, some of the touted benefits included information sharing between organizations and increased patient engagement. However, the HITEC legislation of 2009 that mandated the implementation of EHRs had weak interoperability rules. Why was that? Was it intentional or was it oversight? Did regulators think the market would demand interoperability? Was it a planned second round goal?

Since there was no incentive for interoperability and no documented plan for future inclusion, EHR companies saw no need to make the development investment. Although it has not been publicly stated, it is understood that EHR companies see interoperability as a threat to their business model. You see, while the intent is to enable patients to share PHI with different providers, it also enables institutions to more easily change EHR vendors. Some healthcare institutions also feel threatened by the mobility of patients and their records as a potential way to lose business. Ultimately government intervention is necessary to overcome these perceived threats, so that everyone can benefit from an increase in healthy competition and incentive to improve the quality of care.

In addition and related to interoperability requirements, the new rules would also take on information blocking, a practice used to deliberately block other entities from accessing an institution’s data. Blocking has been used in the past to make it difficult for patients to move between healthcare systems. This gives the CMS power to name information blockers that continue to use the practice and eliminate blocking except for circumstances that might compromise information security. (we will explore this more in a later blog)

Implementing interoperability will be costly up front, but cost benefit analysis by the office of management and budget estimates a net benefit of $2.9 billion to $8.7 billion in the first year. While there is no breakdown of the financial benefit or who it goes to in the proposed rules, we can extrapolate that better data mobility will improve efficiency with better informed decisions and reduce waste in the form of redundant procedures. It is also still vague as to who will bear the cost of development. Is it the EHR vendor? The provider? Will the government offer grant incentives?

The real challenge is getting it done right. How will the changes affect usability? Will doctors be involved in this new interoperability push? Regulation has negatively impacted physicians before. EHRs are notoriously lacking in good user friendly design. Developers and EHR vendors can build the systems, but lack knowledge in clinical workflow and language. The interoperability needs to be done in a way that does not add technical time burden to providers. It needs to be implemented in a way that is secure but easy to send and receive data between institutions and EHR systems.

There are still many obstacles to implementing interoperability. It will take input from all stakeholders, but providers and patients need to be the focus of the end result.