LAS VEGAS—Dr. Juan Espinoza, an academic pediatrician in Los Angeles, uses a NextGen electronic health-record system when he sees patients at AltaMed, a not-for-profit chain of 43 federally qualified health centers in Southern California. But when one of his patients is treated at Children's Hospital Los Angeles, which is a Cerner Corp. customer, those records don't easily flow between systems.
It is “one of those less desirable situations where two EHRs don't talk to each other,” he said. “We feel a lot of the pain everyone here is talking about.”
He was speaking at last week's annual Healthcare Information and Management Systems Society meeting that drew over 40,000 health IT officials, vendors and consultants to Las Vegas. Obama administration officials kicked off the extravaganza with a pledge from 17 major health IT developers, 16 large healthcare provider organizations and 17 healthcare associations and medical societies to promote patients' access to their own electronic health records, eschew data-blocking and use federal standards to promote interoperability—the industry buzzword for the easy flow of digital patient records from one provider to another, or between providers and patients.
Will this voluntary pledge matter any more than previous promises—not to mention the government's requirement that the $31 billion in federal subsidies shoveled out to providers and their vendors for EHRs result in full interoperability? In other words, will Dr. Espinoza's problem be solved anytime soon?
“I don't know,” said H. Stephen Lieber, CEO of HIMSS, one of the pledged associations. “It's kind of like we support honesty in government. We shouldn't even have to do this.”
The government began rounding up signatories to the pledge last fall, according to Zane Burke, president of Cerner, which also made the pledge. “It's unethical and immoral to withhold information,” he said. Moreover, he added, “If you're not interoperable in the next five years, you'll be obsolete.”
Still, last week's pledge smacked of a standard public relations move by a government agency—in this case the Office of the National Coordinator for Health Information Technology—charged with ensuring taxpayer financing generates the desired results. “ONC came to us (in early January) and said, 'We're looking to make a splash at HIMSS,' ” said Jeff Smith, vice president of public policy at the American Medical Informatics Association, another pledge signatory. “There's a lot of finger-pointing about who's impeding interoperability.”
AMIA wrote to HHS in January, stating that the pledge should be “fairly descriptive (of) what patient access means. That means the full medical record, not just a summary.”
Epic Systems Corp., another prominent EHR developer, also signed the pledge, despite its long-standing claim that nothing stands in the way of its platform's records flowing easily onto other systems.
“The pledge is merely an underscore to the work we've been doing the past 15 years and will continue doing,” said Eric Helsher, Epic's vice president of client services.
Providers say deliberate data-blocking rarely occurs. “I never experienced it,” said Russell Branzell, CEO of the College of Healthcare Information Management Executives and a former chief information officer. “Occasionally, there were higher expenses than I thought there should be, but if I ask a vendor to write 27 custom interfaces, should they do that for free?”
As he headed back to Los Angeles, Dr. Espinoza was “cautiously optimistic.” The ONC-organized pledge offers “a glimpse of what other countries (already) do with population e-health management and improving care for patients,” he said.
