Last month, the Government Accountability Office (GAO) released a report, “Nonfederal Efforts to Help Achieve Health Information Interoperability,” in which representatives from 18 health information exchange (HIE) initiatives described a variety of efforts they are undertaking to achieve or facilitate electronic health record (EHR) interoperability. The stakeholders involved concluded that to date, interoperability has remained limited.
The stakeholder and initiative representatives GAO interviewed described five key challenges to achieving EHR interoperability, which are consistent with challenges described in past GAO work. Specifically, the challenges they described are (1) insufficiencies in health data standards, (2) variation in state privacy rules, (3) accurately matching patients’ health records, (4) costs associated with interoperability, and (5) the need for governance and trust among entities, such as agreements to facilitate the sharing of information among all participants in an initiative.
The report also found that changes to the Centers for Medicare & Medicaid Services (CMS’s) Medicare and Medicaid EHR Incentive Programs would also help move nationwide interoperability forward. Specifically, representatives from 10 of the initiatives noted that efforts to meet the programs’ requirements divert resources and attention from other efforts to enable interoperability.
After the report’s release, a couple of noteworthy health IT experts took to Twitter to share where they thought the GAO research fell short. One of these two people was noteworthy health IT leader Arien Malec, vice president of data platform and acquisition tools for RelayHealth (the Alpharetta, Ga.-based McKesson business unit that focuses on improving clinical connectivity) and former staffer at the Office of the National Coordinator (ONC). Malec recently spoke with Healthcare Informatics Senior Editor Rajiv Leventhal about what he specifically disliked about the report, what the industry can do better to achieve interoperability, and what he thought about the meaningful use final rules released last week. Below are excerpts of that interview.
What about the GAO interoperability report particularly bugged you?
Well, first off, there were a couple things I liked about it. For one, there was unanimity around the need to get consolidation around value-based payments and clarify meaningful use so we’re not criticizing providers. My general critique of the report was that it was a superficially descriptive report in that it talked about a bunch of initiatives but didn’t help get a layer down in terms of where policy needs to go and the drive towards person-centered interoperability. It wasn’t that I thought it was incorrect or not factual or came to terrible conclusions, but I saw it as a missed opportunity to get deeper into driving what would be required for true person-centered interoperability.
What do you see as “true person-centered interoperability?”
By person-centered, I mean that a person has access to his or her complete record, that it’s available to providers to provide care, and that it’s available to the care team to drive improvements in health. This doesn’t just mean around a person-mediated exchange, but the ability for all the members of the care team to have access to the complete record. What’s important about that is there have been a number of initiatives that have driven EHR-to-EHR specific interoperability, meaning I can open up an interface and interface to my EHR. That’s fine and necessary, but it’s not sufficient for person-centered interoperability. It was a missed opportunity to look at the initiatives. This person-centered perspective is the view that the ONC Interoperability Roadmap also has as its definition. You’re starting to see some consensus around interoperability beyond EHRs and interfaces, and more towards what information is required to provide optimal care.
There have been some criticisms that ONC’s Roadmap is too broad and not actionable enough. Do you think that’s fair?
Generally, McKesson’s position here has been that the right role of government is to set a clear destination, put in place the right levers, particularly in terms of payment policy, not micromanage, and not define the ‘how’ too much. Our perspective is that with a clear enough picture and destination, and with efforts like CommonWell and the Argonaut Project, I think we have proven that as an industry we can rise to the challenge and do the work to improve interoperability. I appreciate the picture that was painted with the Roadmap of where we need to go, pointing out some of the federal action. And I’m starting to see HHS double down aligning on value-based payment on a consolidated set of measures, making sure that those measures are more outcome-centered rather than process-centered. Those are all helpful steps. I don’t think that the role of government in this area is to move all of the pieces around to achieve interoperability. In that sense, I appreciated the Roadmap.
How would you state the level of interoperability in the U.S. today? Are we moving fast enough?