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BUSINESS OF
In a related blog post by the U.S. Food and Drug Administration
(FDA), Janet Woodcock, director of the FDA’s Center for Drug
Evaluation and Research, lamented that the EHRs’ lack of interop-
erability is a fundamental design defect, implying that it has nega-
tive impact on the FDA’s work to monitor the safety of
FDA-regulated medical products, in order to improve public health.
Ms. Woodcock called for further standardization of data and the
way it is exchanged, and she called for the use of standard terms for
“adverse events” or “treatments” so that EHRs can communicate
with each other. If patient safety is front and center, then the in-
dustry should make fixing these design flaws a top priority.
AMA Town Hall
In a recent (July, 2015) American Medical Association (AMA)
town hall meeting in Atlanta, physicians expressed widespread dis-
content with EHRs and the federal government’s Meaningful Use
program. AMA’s President, Steven J. Stack, M.D., stated that
more than 80 percent of U.S. physicians use EHRs, yet something
is not right when too often these tools “blunt their efficiency, di-
minish their effectiveness, and get between them and their pa-
tients.” In addition, Stack made the case that EHRs today are not
interoperable and “don’t talk to each other,” creating digital silos.
He emphasized that the AMA’s goal is to promote EHR interop-
erability, improve usability, and increase patient engagement.
Stack further criticized the Meaningful Use program for proposing
new requirements and new stages “without making good use of
our current knowledge about what works and what doesn’t.” U.S.
Rep. Tom Price (R-Ga.), M.D. told the attendees that “Meaning-
ful Use sounds wonderful. The problem is that it oftentimes is in-
consistent with the product and the work that’s required. And, in
this instance, I believe we’re on the path to an un-meaningful and
oftentimes useless product.” He further argued that one of the
major problems with EHRs is that they are “removing the science
from medicine” by asking doctors to “check certain boxes” and to
perform tasks designed by those without the medical experience
or firsthand knowledge of the physician-patient relationship “that
is the key to quality healthcare in our country.”
AHA Perspective
According to a report from the American Hospital Association,
hospitals are sharing more data than ever, due to EHRs, but limi-
tations exist as well as barriers due to high costs. The authors of the
report state that hospitals have tried to overcome interoperability
barriers through the use of interfaces and health information ex-
changes (HIEs) but they admit that at best, these are costly
MEDICINE
workarounds, and processes that will not get the country to true in-
teroperability. Among the issues the report points out is the expense
of the interfaces that hospitals use to connect disparate systems,
such as lab, pharmacy, and imaging. A single hospital with a fully
integrated EHR might have dozens, while a large health system with
multiple sites might have hundreds or thousands. One example
listed was Truman Medical Centers in Kansas City, Mo., that has
more than 55 connections to external organizations. Truman esti-
mates the average cost of an interface is $10,000 to $20,000, yet
that doesn’t include the cost of IT staff to implement and maintain
these connections and systems.
Conclusions
The United States has expended extraordinary efforts and
money towards the digitization of its healthcare system, and pol-
icymakers look to HIT as a means of making healthcare systems
safer, more affordable, and more accessible, but there remain sig-
nificant barriers to achieving these goals. I realize this article raises
many questions about the appropriate role of federal government,
healthcare stakeholders, and vendors in creating workable stan-
dards to improve EHR interoperability. One aspect of this prob-
lem seems to be the answer to this simple question “Who’s in
charge?” and “Who should be in charge?” Robert Wergin, M.D.,
board chair of the American Academy of Family Physicians
(AAFP), in responding to the ONC for HIT’s interoperability
roadmap indicated that “It’s time for action on interoperability.”
He also stated that AAFP members “…do not sense the necessary
level of urgency to achieve this important goal (interoperability)
and call on ONC to further accelerate this work.” The argument
is that vendors have reaped huge profits from the HITECH Act
while not being held responsible for poor design and lack of in-
teroperability, and that physicians and their patients shouldn’t
have to wait until 2024 for improved interoperability. I would
agree with this assessment, and in my opinion it will only succeed
if the provider leads the charge, and continues to be an active
participant in the move towards interoperability.
Joseph P. (Joe) Gonzales is a “Specialist Master” with
Deloitte Consulting, LLP. An Adjunct Faculty with
UTSA, he has taught in the MBA Program, Business of
Healthcare Track. Joe is a Fellow in the American College
of Healthcare Executives, and has years of experience in healthcare as a
hospital administrator in the Army, as CEO of a county hospital in
rural Florida, and as a consultant with DoD and commercial health-
care projects.
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