Despite all the talk of interoperability among policy-makers, providers and even technology vendors, today’s crop of electronic health records will continue to be “fortress” applications that hinder information sharing until incentives change and, perhaps most importantly, end users demand interoperable systems, according to a new Chilmark Research report.
“The EHR vendors are bad,” Chilmark research analyst and lead report author Brian Murphy told MedCity News, “but they’re just doing what their customers want them to do.”
According to Murphy, “In some sense the providers are more culpable.”
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EHR vendors are getting the brunt of the criticism, Murphy noted. For example, on Thursday, the Senate Health, Education, Labor and Pensions Committee held another hearing on “information blocking,” a term Congress coined last year in directing the Office of the National Coordinator for Health Information Technology to report on the poor state of interoperability.
“I see it as a bit of window dressing,” Murphy said. Not every attempt at information blocking will lead to patient harm, he noted. “My information is blocked. So what?” he said.
The report, called “Moving to Open Platforms: EHR Vendor Strategies and Assessment,” advocates a need for application programming interfaces and “platform as a service” (PaaS) technologies. “APIs are prevalent in every part of the economy except healthcare. Virtually every PaaS offering has comprehensive APIs for third-party developers,” the Chilmark document said.
One major problem mentioned in the report?
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A prevailing view in HIT has been that opening applications to developers increases the risk that customers could more readily migrate to a competitor. Many HIT vendors fear that the data in their applications, if made more readily accessible via APIs, will flow to a competitor’s product. HCOs, motivated by fee-for-service (FFS) models, see patient data as a revenue assurance too land also fear patient defections from more liquid data. Vendors and providers also share legitimate concern that easier access by third parties could compromise patient safety and privacy.
“Fee for service is a potent force for the status quo,” Murphy said. “Until that changes, nobody’s feet are to the fire.”
While the proposed Stage 3 Meaningful Use rules do call for greater use of APIs, many have called for Fast Healthcare Interoperability Resources (FHIR) to be the “universal API across healthcare,” the report said. However, FHIR remains under development by Health Level Seven International.
While waiting for HL7 to finalize FHIR, Murphy said that some providers and vendors are waiting around, with some even presuming Meaningful Use is dying. “Many critics [of MU] are pretending that Meaningful Use never happened,” he said. “HL7 FHIR isn’t ready yet, so let’s just do nothing” seems to be one common attitude, he added.
At least one of our MedCitizens, healthcare attorney David Harlow, has expressed noticed this as well.
It is a mistake to lean so heavily on FHIR, Murphy said. “No industry that has a single API standard provides a uniform, single view for everybody in the industry,” he said.
Murphy did add that he believes the API strategy “is going to happen one way or another.”
Chilmark is planning another report later this year that will analyze the work of health information exchange— which Chilmark now refers to as clinical network management systems — vendors in pursuit of the PaaS strategy.