A big thanks to A. Akhter, MD for pointing out the 2014 Omnibus Appropriations bill (word is in Washington they’re calling it the CRomnibus bill) which asks ONC to address the interoperability challenges. HIMSS highlighted the 2 sections which apply to ONC and healthcare interoperability:
“Office of the National Coordinator for Information Technology – Information Blocking.
The Office of the National Coordinator for Information Technology (ONC) is urged to use its certification program judiciously in order to ensure certified electronic health record technology provides value to eligible hospitals, eligible providers and taxpayers. ONC should use its authority to certify only those products that clearly meet current meaningful use program standards and that do not block health information exchange. ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in CEHRT, and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use. The Committee requests a detailed report from ONC no later than 90 days after enactment of this act regarding the extent of the information blocking problem, including an estimate of the number of vendors or eligible hospitals or providers who block information. This detailed report should also include a comprehensive strategy on how to address the information blocking issue.”
“Office of the National Coordinator for Information Technology – Interoperability.
The agreement directs the Health IT Policy Committee to submit a report to the House and Senate Committees on Appropriations and the appropriate authorizing committees no later than 12 months after enactment of this act regarding the challenges and barriers to interoperability. The report should cover the technical, operational and financial barriers to interoperability, the role of certification in advancing or hindering interoperability across various providers, as well as any other barriers identified by the Policy Committee.”
Everyone is talking about the first section which talks about taking “steps to decertify products that proactively block the sharing of information.” This could be a really big deal. Unfortunately, I don’t see how this will have any impact.
First, it would be really hard to prove that an EHR vendor is proactively blocking information sharing as required by EHR certification. I believe it will be pretty easy for an EHR vendor to show that they meet the EHR certification criteria and can exchange information using those standards. From what I understand, the bigger problem is that you can pass EHR certification using various flavors of the standard.
It seems to me that Congress should have really focused on why the meaningful use requirements were so open ended as to not actually get us to a proper standard for interoperability. They kind of get to this with their comment “certify only those products that clearly meet current meaningful use program standards.” However, if the MU standards aren’t good, then it doesn’t do any good to make sure that EHR vendors are meeting the MU program standard.
Of course, I imagine ONC wasn’t ready to admit that the MU standard wasn’t sufficiently defined for quality interoperability. Hopefully this is what will be discovered in the second piece of direction ONC received.
I could be wrong, but I don’t think the problem is EHR vendors not meeting the MU certification criteria for interoperability. Instead, I think the problem is that the MU certification criteria isn’t good enough to achieve simple interoperability between EHR systems.
If you think otherwise, I’d love to be proven wrong. Does this really give ONC some power to go after bad actors?
As an extension to this discussion, Carl Bergman has a great post on EMR and EHR which talks about what’s been removed from this bill. It seems that the Unique Patient Identifier gag rule has been removed.
[…] Sometimes what Congress leaves out is as important as what it puts in. The CRomnibus Act has an example for HIT. In its hundreds of pages, Congress took three actions to promote HIT interoperability. Two have been widely reported: It ordered ONC to report on interoperability data blocking and to spell out other impediments. […]
I’d say you’re right on, John. It’s going to be difficult (potentially impossible, short of NSA-level email hacking) to prove, and adding MORE to ONC’s plate is probably the last thing they need right now. Anything short of a major overhaul to MU requirements and timelines isn’t going to do much good for the attesting hospitals and EPs at this point.
John I think the answer can be rather simple. The ONC should set reasonable standards for the “performance” of any import or export request. The technology is not the problem, it is the willingness and responsiveness of the vendor or enterprise. Any valid request that is driven by a customer should be met with a timely response. There are vendors that stall for 3 months when a data export is requested, with the intent to reduce churn and lock in customers. In addition, there are enterprises that require length contracting and can take an entire year to plug into their HIE for data exchange. There should be simple and reasonable timelines applied and enforced as part of the ONC guidelines for continued certification. This is implied in the ONC requirements for MU certification but not clearly stated and tied to continued certification.
[…] has also shown initiative on promoting interoperability asking the ONC to investigate information blocking by EHRs. Most of the ONC’s roadmap for the next three years is similar to Meaningful Use Stage 2 […]