EMR today and tomorrow

In the May 2013 issue of MLO, I wrote an article titled “The state of EMR interoperability in healthcare: five observations.” (https://www.mlo-online.com/articles/201305/the-state-of-emr-interoperability-in-healthcare-five-observations.php.) What’s interesting about the current state of Health Information Technology (HIT) is that, in spite of all that’s changed in the last few years, some of the surroundings look surprisingly familiar.

Two years ago, I wrote about an impending digital storm, with the electronic medical record (EMR) directly at the center. Indeed, there has been a frenzy of activity in and around EMRs since then, but with technological and regulatory factors in flux, there is no certainty about how further events may play out.

How successful have efforts been to get many disparate systems and devices to talk to each other? Do clinicians really have better access to information? Are they making better clinical decisions as a result? Are providers reaping the rewards of more efficient processes and systems? And, how do the regulatory and legislative contexts play into the answers to these questions?

While I would never presume to fully address all of these questions in the space allotted, here are a few more observations about where interoperability in healthcare has gone, and where it might be going.

• The stakes are still high. In accordance with the Affordable Care Act, the U.S. government has paid out billions of dollars in EMR incentives to more than 400,000 healthcare providers between 2011 and June 2014. And in order to qualify for those incentives, providers have invested billions in implementing and upgrading their EMR systems. A recent report from the federal Office of the National Coordinator for Health Information Technology (ONC) stated that more than half of primary care physicians have access to an EMR system and that 94 percent of hospitals had certified this technology by the end of 2013.
• Difficulties are being realized. Yet, according to data from the Center for Medicare and Medicaid Services (CMS)¹ and a recent survey by the Medical Practice Insider website,² fewer and fewer physicians and hospitals are applying for Meaningful Use—Stage 2 incentives, due to the frustration and limited success of those who have. It’s really expensive to implement or upgrade an EMR system; and just having a system in place is no guarantee that productivity will increase. According to the ONC’s annual report to Congress last year, “Despite progress in establishing standards and services to support health information exchange and interoperability, practice patterns have not changed to the point that health care providers share patient health information electronically across organizational, vendor, and geographic boundaries.”³ Why might that be?
• A question of standards. Electronic health information is still not sufficiently standardized to allow for seamless interoperability. Technical and medical vocabulary, structures, and formats are still inconsistent across platforms. It’s not that technical standards don’t exist, but rather that current standards are not comprehensive or enforceable. As a result, providers still can’t easily obtain data from different devices or share data between institutions. Until this hurdle is overcome, interoperability can’t realistically happen. There has been significant consolidation among EMR vendors over the last couple of years, however, which might make standardization more likely.
The carrot vs. the stick. Up to now, the federal government has used the carrot approach to facilitate EMR adoption and interoperability by offering incentives to providers that qualify, and this has been successful in that a lot of providers have literally “bought in” to the program by installing EMR systems. Seeing that momentum is slowing due to a lack of standardization, however, legislators have decided to pick up a big stick instead.

The 21st Century Cures Act, sponsored by Representative Fred Upton (R-MI), was unanimously approved by a House subcommittee in May, and the bill is currently making its way through Congress. Its primary thrust is to relax some regulations on drug development and approval. It would also, however, hold EMR vendors’ feet to the fire through tough interoperability provisions that, if not met, would levy stiff penalties for a lack of data-sharing capabilities. The bill would require EMR software to comply with a yet-to-be-defined metric for interoperability by January 2018, or else face “decertification” from the government’s EMR incentive program. Such an approach is fraught with uncertainties, and opponents have not hesitated to highlight them. Should the bill ever make its way through the gauntlet of Capitol Hill politics and be signed into law by the president, its language might change along the way. But clearly, patience for the status quo of interoperability is wearing thin. And, of course, what affects EMR vendors will have both direct and indirect impact on their customers, clinical laboratory scientists. 

 

• So what does the future hold? Well…first it’s going to require stakeholders to take a long-term view. Interoperability is inextricably linked to time, and no amount of money or legislation will change that fact. Seeing the critical need for interoperability, a group of five healthcare providers and five EMR companies have banded together to form The Argonaut Project. Their goal is to develop a common interface for sharing a specific set of patient records and documents, focused mainly on Meaningful Use data. Two of those data subsets include information on diagnostic lab tests ordered by physicians, as well as lab and pathology results. Imagine a lab in Hospital A being able to seamlessly share this kind of information with a lab in Hospital B, C, or D. That may be the face of the future.

 

References

1. Centers for Medicare and Medicaid Services. Medicare and Medicaid HER Incentive Programs. HIT Policy Committee. November 4, 2014. www.cms.gov. Accessed June 5, 2015.
2. Irving F, ed.2015: End of the road for meaningful use? Medical Practice Insider. http://www.medicalpracticeinsider.com/news/2015-end-road-meaningful-use. Accessed June 5, 2015.
3. The Office of the National Coordinator for Health Information Technology (ONC) Office of the Secretary, United States Department of Health and Human Services. Report to Congress. October 2014. Update on the adoption of health information technology and related efforts to facilitate the electronic use and exchange of health information. www.healthit.gov. Accessed June 5, 2015.