The Tower of #EMR Babel | Information Blocking http://t.co/pknBTbsbTG w/ @blackweldermd quote that sums it up pic.twitter.com/PFJSvrwAHD
— Eric Topol (@EricTopol) May 27, 2015
It’s the sad state of interoperability. This week when I was teaching an EHR workshop I asked for those attending to define what an Electronic Health Record was in their own words. I’d say 90% of them said something about making the healthcare data available to be shared or some variation on that idea. This wasn’t surprising for me since I’ve heard hundreds and possibly thousands of doctors say the same thing. EHR is suppose to make it so we can share data.
While people pay lip service to this idea and just assume that somehow EHR would make data sharing possible, that’s far from the reality today. This is true even in some organizations where they own both the hospital and the ambulatory provider. How sad is this? Extremely sad in my book.
I’ve often wondered what would change the tide. I’ve been long hopeful that ACOs and value based care would help to push the data sharing forward, but that’s going to be a long process. The private HIEs are working the best of any HIEs I’ve seen, so maybe the trend of hospitals acquiring small practices and hospital systems acquiring hospital systems will get us to EHR data sharing nirvana. Although, I don’t think it’s going to make it there in most communities. Instead it’s just going to have a number of large organizations not wanting to share data as opposed to some large and some small ones.
Do people really have much hope for true EHR data sharing? Does FHIR give you this hope? I’m personally not all that optimistic. We all know it’s the right thing to do, but there are some powerful forces fighting against us.
If ONC and CMS would stop the insanity of MU and PQRS/VBM/MIPS and focus SOLELY on interoperability it maybe would have a chance. Bu they won’t by choice. They would need to be accepting of information not from just certified EHR systems, but for any willing provider, even if all they have is a fax machine or secure email. It needs to be inclusive. We need innovation, and not a blistering array of complicated computational tasks that are in the certified systems today. Flush all that. We need to sunset MU and certification of EHRs. We need real focus on providers and workflow, usability, safety, security, efficiency. Right now MU sucks up all the vendor resources for a myriad of complicated measures and objectives that are meaningless to the vast majority of providers. Do we really need EPs counting numerators and denominators still? Let the real market work, not the artificial disaster that has become MU/PQRS/CQM/VBM/MIPS. And pile on a whole new ICD-10 code set, wow, like we really need that now. So the bottom line is, interop is dead as its just too complicated by ONC and CMS (non front line providers driving the bus). If anything, we need a national central HIE. Everyone sends there. All notes, images, everything. We would also need unique IDs, good luck there. We also have to make plans for corrections and non-propagation of incorrect data, and right now, EHRs are so ladled with mistakes and misinformation, its really difficult to pick out what is going on with patients. The current state of CCDA, FHIR etc, is pages and pages of bloated, useless, many times inaccurate information that is essentially worthless. If we could go back to one sentence or paragraph to tell me exactly what is going one in a EPs mind, instead of the templates of crap, I would be in heaven. I am amazed knowing that nearly every front line EP I know is jumping the MU ship and ONC knows the numbers for MU 2 are abysmal that they put out a Stage 3 proposal that is completely tone deaf to the front line providers. In what world are they living? Do they ever speak to a non-sycophant provider? Sheesh. So I think there will be a huge shake up in the future. And as always, the answer will not be from the US government. They just don’t get it. As they only complicate everything. We are a funny group, but front line providers are not something to ignore nor drive out of business, as we are already many hands short and we make the system work.
meltoots,
I’ve been signing the song you’re singing for a while now: https://www.linkedin.com/pulse/20140515213807-6749519-my-plan-to-blow-up-meaningful-use-and-make-it-useful?trk=mp-author-card In fact, I’ve posted about the idea many times before that as well.
Sadly, it doesn’t seem like they’re going to really change paths. We’re stuck with what we have I think. I posted a vision a bit like what you described in an EHR workshop I did recently. Then, the next slide was “What do I think is really going to happen?” Short Answer: More of the same.