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Hospital CIO on Interoperability: With Current Technology, It Can’t Happen

August 12, 2014
by Rajiv Leventhal
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Health IT vet says recent comments that blasted interoperability in healthcare were “mostly fair”
Dick Escue, Valley View Hospital CIO

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.


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.

While the Congressmen put blame on the software vendors such as Epic, Escue says it wasn’t the vendors who were getting money from Congress—it’s the healthcare providers who kept buying the technology. “That’s where I think the blame lies, he says. “We continue to buy software and solutions that require us to do things to build big data centers, and to buy more hardware and software, and pay for things we may never use.” While some people say that has been necessary because Congress created these laws regarding things like meaningful use penalties, Escue says that you don’t have to buy all of this software to achieve that. “I have seen [so many] small hospitals attest without having to throw out everything they have.”

At RehabCare Group, the key to success was demanding a return on investment (ROI) from its IT, says Escue. “If we didn’t get a return on that expenditure, we weren’t going to do it. And that organization did more with IT than anywhere I have worked in my entire life.” Finding cloud-based solutions and stopping the purchase of more software made a real difference on the bottom line, Escue notes, adding that Valley View’s clinics currently use the Watertown, Mass.-based athenahealth’s cloud-based EHR.

But on the hospital side, the IT all requires significant capital investment, and therefore creates a sunk-cost relationship that intimidates hospitals away from exiting, he says. “It does not matter if a hospital ever gets value from the product; these vendors have no incentive to make hospitals successful. But I will say, while the hospital world doesn’t have that option today, it is coming. And I think it will be very compelling when it does happen. It won’t be the same old software that is made to look pretty on the outside. It will be open, mobile and a game-changer,” Escue says.

Simply put, Escue feels that the technology today won’t get it done. “I believe that even if the vendors' hearts were into it, even if they wanted to make their software open and non-proprietary, they just can’t do it. The technology is too old, with most of the software written in the 1970s and 1980s,” he says.

As such, Escue’s advice for other organizations is to not buy software, even though that sounds extreme and exaggeratory. “I make it a rule to have that mindset to demand a return on your IT investment. When you need to hire people, have hardware on site, pay for maintenance and licensing, and buy software, I don’t see how that will lead to an ROI for anyone with that strategy. So until someone comes along—and someone will—I will find a way to use what I have,” he says.

And Escue feels that it will take a new vendor to enter the marketplace to give the industry what it needs to become truly interoperable, similar to the way Salesforce came in and “blew up” the customer relationship management (CRM) business. But right now, Escue says that organizations must be getting frustrated about the money they have spent and the lack of improvement that has been seen. “For them, I would bet that for what they have spent on IT, their operating margins have gotten worse,” he says. And why is that acceptable? It just can’t be.”

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