Why Meaningful Use Should Balance Interoperability With More Immediate Concerns

Posted on March 12, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Frustration over the stubborn blockage of patient data sharing is spreading throughout the health care field; I hear it all the time. Many reformers have told me independently that the Office of the National Coordinator should refocus their Meaningful Use incentives totally on interoperability and give up on all the other nice stuff in the current requirements. Complaints have risen so high up that the ONC is now concentrating on interoperability, while a new Congressional bill proposes taking the job out of their hands.

Such a narrow focus would be a mistake. Coming out of the computer field myself and appreciating the importance of frictionless data exchange (which most programmers figured out how to do long ago), I care about interoperability as much as anyone. I have written written about it repeatedly. But we can’t put off other requirements without at least a plan to get them working.

Take measles. Lots of news reports have documented its alarming re-emergence in American life. Wouldn’t you like to know the rates of innoculation in your geographic area? If so, you’ll be glad to know, according to a report just released by the ONC, that 73% of hospitals eligible for MU incentives were able to report vaccinations to their local public health registry electronically (p. 2 of the report). This doesn’t mean other hospitals failed to report vaccinations, but that they used old-fashioned, error-prone manual systems to do so.

And how about epidemics? A few months ago the American public were scared witless that Ebola would spread throughout our cities. That didn’t happen (although two unfortunate victims died of Ebola in the U.S.), but we don’t have to import our epidemics–we have plenty of our own local infections to worry about, from Lyme disease to life-threatening valley fever (coccidioidomycosis).

So you should be happy to hear that 48% of eligible providers met their public health requirements for syndromic surveillance through electronic submissions, a figure that rose to nearly 75% in several states (p. 4 of the report). This data goes directly from emergency rooms and urgent care centers to agencies monitoring this data nationally, such as the Centers for Disease Control.

These advances come directly from the stringent requirements in Stage 2 of Meaningful Use. ONC data shows that few hospitals could do these things electronically in Stage 1.

There’s a general principle of public policy that lies behind my points here: changes to behavior must balance the evolution of our long-range infrastructure with immediate needs.

We all understand that long-range infrastructure changes are important. We need fee-for-value in payments, and interoperability in electronic health records.

But these things take a long time to bend the cost curve and show results. The current slow-down in the growth of U.S. health care cost is a relief to see, but economists can’t decide whether it’s a long-term trend or the a temporary blip. It might be fall-out from the economic slowdown (perhaps people are even delaying treatment they need), so we can’t depend on the positive trend continuing.

Standards bodies and EHR vendors tout improvements in interoperability, but its disappointingly resistant to adoption. As for accountable care, we’re getting more Accountable Care Organizations, but actual costs savings are scattered and slow to come. This is probably because they suffer from the same interoperability gaps as everybody else in health care, in addition to slow advances in the other clinical decision support and analytics they need.

The solution to infrastructure problems is better infrastructure, but we also need advances in health care right now. That’s why I support Meaningful Use requirements for public health reporting. The next step, as Dr. Kenneth Mandl recommends, is for these agencies to package up their knowledge into apps that clinicians can use, completing the circle. Another insight I’ve learned from the computer field applies here: you’ll never get anywhere if you apply all your efforts to developing your infrastructure.