In mid-July, at a regulatory hearing over interoperability, members of Congress from the federal Subcommittees on Communications and Technology charged health IT vendors, such as the Verona, Wis.-based Epic Systems, with using closed systems.
Rep. Phil Gingrey, M.D. (R-GA) and Rep. Joe Pitts (R-PA) discussed the obstacles that are standing in the way of achieving the promise of health IT in discovering breakthroughs in medicine. In particular, they were concerned over the lack of integration between systems.
Gingrey specifically expressed concern that the Office of the National Coordinator for Health IT (ONC) and the federal government overall have spent roughly $24 billion on products that are not interoperable and not compatible with anyone but the primary electronic health record (EHR) vendor. According to Politico, he mentioned Epic Systems by name, saying the company has collected millions in federal incentives but still operates on closed systems and doesn't allow information to flow from its systems.
He also asked, “Are we getting our money’s worth subsidizing products that are supposed to be interoperable but they’re not? We have responsibility for ONC and the Health Information Technology for Economic and Clinical Health (HITECH) act. We’ve spent tens of billions on non-interoperable products. It may be time for us to look closer at the activities of vendors in the space, given the possibility that fraud is being perpetrated on the American people.”
Even more recently, Senate Democrats have joined Republicans in demanding an investigation into whether heavily subsidized EHR systems are blocking the free exchange of patient health information that was a major objective of the multibillion-dollar federal program. Federal health IT officials have been trying to prompt better health exchange among EHR systems and have made interoperability a central goal of their efforts over the next year.
Needless to say, the lack of interoperability in the healthcare industry has been getting blasted of late. However, according to Politico, Peter DeVault, director of interoperability at Epic, defended his organization by saying that Epic users exchanged 313,000 records with users of other systems last month alone. Ten thousands of those were with federal agencies like the Defense and Veterans Affairs departments, he said.
A CIO’s REACTION
Dick Escue, CIO at the Glenwood Springs, Col.-based Valley View Hospital, with 25 years of healthcare IT experience under his belt, says that the criticism from the Congressmen has been mostly accurate. “If you look at the comment about $24 billion being spent to buy products to facilitate interoperability, yet failed, that’s fair. The systems that we have, that we are hamstrung with in healthcare, absolutely do not enable interoperability,” Escue says. But he adds that it’s not fair to single out Epic. “[Those comments] apply to all of the hospital information system vendors,” he says.
Before getting to Valley View, Escue worked at the RehabCare Group, Inc., a New York City-based for-profit provider of physical, occupational and speech-language rehabilitation services in 46 states. There, the vendors that the organization worked with generally had written their software in the last five or 10 years and leveraged new tools that were web-based, scalable, and probably were delivered as a service, compared with hospitals being locked into contracts, Escue says.
But that was in the ambulatory space. In the acute care space, it’s been a different story, he notes. Having been a customer of a variety of big-name vendors throughout his healthcare career—including Cerner, McKesson, Meditech, and Epic—Escue says that generally, their software was written a long time ago and certainly none of it is what you would call “contemporary,” using modern tools, modern language, and modern techniques. “Anytime you want to do an [EHR] interface, you’re going to have to pay [the vendors], and even then it will be difficult, and even then, they might really drag their feet and not help you do it if they deem it’s not in their best interest. Really, the vendors have control of you.” And because the vendors have antiquated systems, new technology models that are the standard in other industries are not explored in healthcare, he says.