Senate looks at interoperability for electronic health records

The $30 billion federal program to encourage hospitals, health systems and medical practices to adopt electronic health records has led to the rapid replacement of paper-based records. However, interoperability between commercial systems has proven to be a thorny problem for practitioners and policy-makers alike.

At a March 17 hearing of the Senate Health, Education, Labor and Pensions Committee, lawmakers explored the progress on EHR adoption. Committee Chairman Sen. Lamar Alexander (R-Tenn.) said the Obama administration "seems to have complicated the process by rushing ahead with penalties for those who don't adopt EHR systems," even though systems that are certified by Office of the National Coordinator for Health IT can fail to offer the necessary functionality or conform to program requirements.

Julia Adler-Milstein, a health policy expert who teaches at the University of Michigan, said technology is not the main barrier to interoperability. "EHR vendors do not have a business case for seamless, affordable interoperability across vendor platforms, and provider organizations find it an expense that they often can't justify," she said in testimony before the committee.

The problem isn't just between commercial IT systems, she added. Large health care systems serving the same market have an incentive to use data as a competitive edge to retain medical practitioners and patients.

A recent policy paper from the Brookings Institution backs that view. "Creating a real business case for practical interoperability that is relevant to particular areas of clinical practice, rather than just an incentive for exporting data without clear impact on care, would go a long way towards improving usefulness and interoperability without the need for a complex set of process measures and detailed standard design requirements," the paper states.

The interoperability problem is most keenly felt by smaller practitioners, said Robert Wergin, a Nebraska doctor and president of the American Academy of Family Physicians. That's because there is an added cost to have EHR systems wired to share data with competing platforms and often a charge on a per-patient or per-transaction basis. ergin told the committee that he wanted to see Congress "delay federal penalties [for practitioners who don't hit ONC targets for using EHRs] until interoperability is achieved." He also advocated requiring vendors to use open API technology to enable cross-system communication by the end of next year.

It's not clear if Alexander plans to introduce legislation that would alter the scheduled unfolding of incentives and penalties for EHR adoption under the meaningful-use program, which includes interoperability standards.

On the House side, Rep. Michael Burgess (R-Texas), a physician, has released the draft of a bill that would put interoperability certification in the hands of a new, congressionally appointed organization. The bill would eliminate the federal advisory committee process currently in place to develop standards for consideration by ONC.

It would also require that EHR systems meet certain benchmarks for interoperability, including not blocking access between qualified systems and allowing access to patient data by authorized users at a single location.