There are now a total 880,000 professionally active U.S. physicians, working in 200,000 mostly small private practices (100K with one or two members and 160,000 with 8 or less). Because of ARRA/HITECH’s carrots and sticks, over 60% of them have now installed ONC-certified EHRs. There are also a total of more than 8,800 hospital-based and over 5,600 independent, community-based clinical labs using LIS products sold by over 200 vendors, many of which are using proprietary LIS-Provider Link (LPL) software and middleware from a least a dozen EHR-LIS system integrators. Creating bidirectional ambulatory and inpatient EHR-LIS interfaces reportedly costs in the range of $10,000 to $50,000 per installation.
The owners of every lab business and physician practice would love to see the day that open source interoperability standards (for both data transport and content exchange) usher in the era of “commoditized connectivity” (what Dr. Doug Fridsma describes as “the arrows between the boxes”) between physician EHRs (which are used to order the tests) and LISs (which process the patient specimens and make the test results available to the ordering physician, and more recently with the new CLIA regulations, directly to patients). Currently however, there are no marketplace financial incentives for EHR and LIS vendor businesses to replace their millions of expensive customized interfaces (an innovation that sustains their business model) with the lower cost, more efficient and convenient commodity interfaces (an innovation that would disrupt their business model).
The potentially very good news (for labs, private practice physicians and vendors who are adapting to the constructive disruption of HIE 1.0) is that with the emergence of over 600 ACOs and thousands of PCMHs, tangible value-driven, risk-based incentives, a low profile, open source triad of EHR to Lab LIS interoperability standards are moving from pilot projects to production/deployment versions..
Since January 2011, right on the successful launch of the Direct Project Protocol pilots, over 3,000 individuals and organizations, including some of the biggest vertically integrated EHR/PHR, LIS, and HIE platform vendors in the U.S., have been busily creating an extensive portfolio of open source standards specifically aimed at overcoming many of the major barriers to health IT connectivity and seamless interoperability. You can find a good chronology of these efforts in the link to the archive of S&I Framework newsletters here.
The S&IFramework’s Lab Results Interface (LRI), Lab Orders Interface (LOI) and electronic Directory of Services (eDOS) Initiatives have been underway since January 2011. Notwithstanding the potential major impact on the global health IT systems interoperability markets and its vendors, the LRI+LOI+eDOS Initiatives have received little media coverage and exposure outside of some health IT media channels.
Over the next 3-5 years, if they are demanded and widely adopted and used by the knowledgeable customers of EHR and LIS vendors, the HL7-ballotted, normative versions of these three components of an open source interface solution can significantly reduce the costs of creating and maintaining millions of customized EHR-LIS interfaces and enable more efficient, less costly and more accurate ordering and reporting of the results of all 5,000+ available clinical lab tests to physicians and their patients.
If that actually occurs, the vendors of EHR, PHR and HIE platform products will ultimately have to consider reinventing their venerable business models by embracing disruptive IT innovations that enhance the value of the applications “inside their boxes” and can allow them to compete successfully on the basis of the price and quality of their products.