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Meaningful Use Today…Meaningful Interoperability Tomorrow?

May 22, 2014
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Last November, a white paper written by the JASON initiative within the McLean, Va.-based Mitre Corp., and funded by the Agency for Healthcare Research and Quality, concluded that the current lack of interoperability among the data resources for electronic health records (EHRs) is a major obstacle to the effective exchange of health information.

Further, the white paper says that the criteria for Stage 1 and Stage 2 of meaningful use, “while surpassing the 2013 goals set forth by [the U.S. Department of Health and Human Services] HHS for EHR adoption, fall short of achieving meaningful use in any practical sense. At present, large-scale interoperability amounts to little more than replacing fax machines with the electronic delivery of page-formatted medical records. Most patients still cannot gain electronic access to their health information. Rational access to EHRs for clinical care and biomedical research does not exist outside the boundaries of individual organizations.” The paper recommends that CMS embrace Stage 3 meaningful use as an opportunity to break free from the status quo and embark upon the creation of a truly interoperable health data infrastructure.

I have seen some reaction to this white paper as if it’s saying that the “meaningful adoption” of EHRs has not been a success to date. However, I don’t think that’s the point the study is trying to make; it is instead asking if we have achieved “meaningful interoperability.” In fact, the report’s authors do acknowledge the benefits of EHR adoption and the need for it, praising the Office of the National Coordinator for Health IT (ONC) and HHS for tackling one of society’s most vexing issues, while admitting that improved exchange of health information could serve a number of useful purposes. The report’s authors write, “The evidence for modest, but consistent, improvements in healthcare quality and safety is growing, especially over the last few years. Evidence has recently emerged to indicate that EHRs can indeed reduce the costs of healthcare in the general community setting, and not just in an academic hospital and its affiliated practices or in a large-scale healthcare enterprise.”

After all, new government statistics show that almost 80 percent of doctors in the U.S. have switched from paper to EHRs, a sign that is certainly a step in the right direction. Additionally, as of February, 453,426 eligible professionals had registered for the Medicare or Medicaid meaningful use programs, as had 4,711 hospitals. What’s more, having patient data on an EHR shows a significant improvement from when the industry was working on paper, just a short time ago.

As providers work on tasks to meet Stage 1 and 2 requirements, the benefit of an electronic system will prove invaluable. Sure, there was the disappointing news that only four hospitals have fully attested to Stage 2, but hey, look at the bright side—we spoke to one of those four and got the story on how they did it! In all seriousness, though, the paper isn’t saying that the meaningful use program is a sham or a waste of time, just that there should be concern in the progress to date regarding the health data infrastructure.

And to that end, I agree; the current level of interoperability is simply not good enough.  Dereesa Reid, CEO of the Irvine, Ca.-based Hoag Orthopedic Institute, an orthopedic hospital with 70 beds and nine operating rooms, has similar thoughts. I recently spoke with Reid—who has no formal connection to the publication of the white paper—about the study and its potential impact, and she thinks that the paper’s overall philosophy could be a game-changer.  A big problem, says Reid, is that patient data is currently in a multitude of silos right now. And while Stage 1 puts the onus for success firmly on the shoulders of eligible hospitals and professionals, Stage 2 requires participants in the program to not only engage each other but also their own patients. Currently, many in the industry are working on their patient portals, and Reid says that while that’s a great thing—as patients should be able to get all of their information in one place—due to the way the industry is in its current state, the portal will just be a bigger silo.

A few months back, a public conference co-hosted by the Gary and Mary West Health Institute (WHI) and the ONC, Malcolm Gladwell, journalist, bestselling author, and speaker spoke about the importance of interoperability in healthcare, using other industries to serve as a lesson, as Gladwell has very little healthcare experience himself. Reid also brought up other industries, referencing how the internet became interoperable in the early 1990s. “Think about where we would be today if we had not made the internet have the ability to have standards and communicate,” she said.  “Similar to healthcare, you have to have a very high degree of patient privacy and security, but we would be delivering much better healthcare if we were able to federate all that data and be able to look at it across the [continuum of care].”