Providers Ask HHS to Address EHR Interoperability Barriers

"Strict MU requirements and deadlines [do not] provide sufficient time to focus on achieving interoperability" says a letter co-signed by eight provider organizations and large health systems.

Systemic snags and glitches around the interoperability of electronic health records are frustrating providers and doing little if anything to improve patient care or reduce costs, a group of provider organizations and large health systems says.

In a letter this week to Health and Human Services Secretary Sylvia M. Burwell, several provider groups and professional associations, including the American Medical Association, reaffirmed their support for meaningful use of EHR. However, the groups complained that stubborn proprietary barriers, the complexity of the requirements, and an accelerated timetable put forward by HHS have made it difficult to realize interoperability.

"Currently, health information stored in most EHRs/EMRs and other HIT systems and devices do not facilitate data exchange but 'lock-in' important patient data and other information that is needed to improve care," the letter says.

Citing data from the Office of the National Coordinator for HIT, the letter notes that only 14% of physicians can electronically transmit health information outside of their organization. The main barriers to data exchange continue to be "strict MU requirements and deadlines that do not provide sufficient time to focus on achieving interoperability."

"This dynamic is also in part due to the strict EHR certification requirements that have forced all the stakeholders involved to focus on meeting MU measures as opposed to developing more innovative technological solutions that will enhance patient care and safety while growing the marketplace," the letter says.

Paul Merrywell, vice president of information systems and CIO at Mountain States Health Alliance, which cosigned the letter to Burwell, says the Johnson City, TN-based health system is fairly well along in the meaningful use continuum but that the pace of implementation is "numbing" and the process still requires too many "manual processes and hand-holding."

"It is not a seamless process. It is not clicking-a-button easy because of the lack of interoperability between sending and receiving systems," he told HealthLeaders Media.

"For example, we have a certified product at Mountain States and a certified product at some other health system. So you would think we would be able to move a standard document from one organization to another programmatically. Well, eventually you can, but even with certified products there are incompatibilities between them due to a lack of interoperability."

In the letter, the eight co-signers recommend a handful of changes that they say could improve the meaningful use process, including:

• Streamline and focus meaningful use certification requirements on interoperability, quality measure reporting, and privacy/security.
• Remove certification mandates and instead allow for a flexible and scalable standard based on open system architectural features such as application program interfaces. This will allow data to move more freely across the healthcare system, reducing data lock-in and promoting more usable systems.
• Foster stakeholder collaboration to promote new HIT that is focused on clinical care needs.
• Remove restrictive MU policies that stifle HIT innovation.
• Allow vendors and providers adequate time to develop, implement, and use newly deployed technology and systems before continuing on with subsequent stages of the MU program. Testing and achievement of specific performance benchmarks should occur before providers are held accountable for any new MU requirements.

The American Academy of Family Physicians was another of the cosigners in the letter to Burwell.

AAFP President Reid B. Blackwelder, MD, a Kingsport, TN-based family practitioner, says the EHR interoperability processes around his practice are almost laughably complex and inefficient.

"Let's just say I saw a patient today in my office and I decided this patient was sick enough to be admitted to the hospital, which is literally on the hill above my office," Blackwelder told HealthLeaders Media. "Well, the hospital has a different EHR. Ours don't communicate. I have to print out my electronic record, which has to be hand carried over and either scanned in or someone takes the time to enter that information into their EHR."

"Whatever happens in the hospital I can access because I have the hospital EHR access code because we are managing our patient in the hospital. But I can't send that information to my office except through paper and scanning, and when you scan a document it now becomes a miscellaneous item that you have to file. It's hard to track. It's hard to do research on the data."

"And when I send them home, I have to do the same thing with the discharge note from the hospital," Blackwelder says. "What's even more frustrating is that the electronic prescriptions from the hospital are going to be from a different system than the one in the office, so I have to reconcile the medication list by hand."

"That is just a practical example in one place but that is what I am hearing from our members," Blackwelder says. "What we have now are siloed electronic records. None of them talk to one another. And even when there is interoperability, it is usually very expensive and the costs falls on the physicians."