Interoperability is a word you seldom hear uttered outside the health care sector (though there it seems to be on the tip of everyone’s tongues), yet it’s something that affects everyone.
Interoperability is the ability — or inability, as is often the case — to easily and securely access and exchange medical data in a format that is usable and useful to the recipient. If you’ve ever been to the doctor and they were able to pull up your complete patient record, that’s likely an example of effective interoperability because that care likely came from multiple providers.
But if you’ve had the opposite experience, which is frightfully common, in which you’ve been frustrated trying to recreate your medical history from memory or to get your records from prior providers, that’s a lack of interoperability. And it’s a much bigger problem in this country than it needs to be.
A New York Times article highlighting this issue noted that “major data gaps, the result of decades of underinvestment in public health, have undercut the government response to the coronavirus and now to monkeypox.”
The U.S. has made great strides in health information exchange over the past 20 years, but there’s still a lot of work to be done. A big part of this was addressed in the 21st Century Cures Act, which not only prohibits information blocking but allows the Department of Health and Human Services to levy fines and other disincentives for noncompliance.
Information blocking (or data blocking) occurs when an individual or entity — such as a health care provider or a health information network — knowingly and unreasonably interferes with the exchange or use of electronic health information. The Cures Act Final Rule, published by the Office of the National Coordinator for Health Information Technology (ONC) in 2020, is set to go into full effect on Oct. 6. It requires that covered entities share all electronic health information maintained in their systems, with certain exceptions.
But last week, 10 health care industry groups, including the American Hospital Association, the American Medical Association, and the College of Healthcare Information Management Executives, called on HHS to postpone the approaching compliance deadline for yet another year — after it was previously delayed due to the pandemic. “Despite our best efforts to educate our members, significant knowledge gaps and confusion still exist within the provider and vendor communities with respect to implementation and enforcement of information blocking regulations,” the organizations said in a letter to HHS Secretary Xavier Becerra.
What this means, quite simply, is that they aren’t ready — even with years of lead time. That is disheartening, to say the least.
As a primary care physician for more than 30 years who was one of the earliest adopters of electronic medical records, I am admittedly at an advantage. But there has been plenty of time for everyone to prepare for this change.
The fact is, interoperability can no longer wait, and information blocking is a serious impediment to providing safe, cost-effective, high-quality care in this country.
Even outside of a pandemic or disease outbreak, gaps in patient data contribute to higher health care costs and worse outcomes, something that’s been documented — once again — in The Commonwealth Fund’s “Mirror, Mirror 2021: Reflecting Poorly” report. The United States ranks last on health outcomes despite spending the most on health care, and has every year since the study began almost two decades ago.
Physicians need to be able to access complete medical histories to do their jobs well. Without it, we risk everything, from the relatively innocuous but wasteful duplication of tests to the potentially more dangerous misdiagnoses and medical errors. Every health care professional, no matter how large or small the organization, should understand the negative consequences of keeping data in silos and what’s at stake.
The good news is that the technology exists to support needed interoperability today, as do the networks and frameworks for data exchange. Support for the existing “network of networks” architecture for health data sharing is another prong of the 21st Century Cures Act, which called on HHS to support a Trusted Exchange Framework and Common Agreement. Under this framework, qualified health information networks (networks of organizations working together to share data) will be designated by the ONC, and it will be even easier to securely access, exchange, and use medical data.
Moving forward with the next phase of the information blocking rules on Oct. 6 as planned is the right thing to do. The time is now.
Steven Lane, a primary care physician with 25 years of experience working with electronic medical records, recently joined Health Gorilla, an interoperability platform, as its chief medical officer.