Numerous obstacles stand in front of full interoperability

A recent webinar and journal article argue that interoperability is the victim of products offered by vendors, sluggish EHR adoption and poor health IT system design.

Interoperability issues have forced many healthcare organizations to implement core clinical information systems that don’t allow flexibility for plug-and-play health IT applications. “Leading information systems provide more comprehensive solutions, but there are often hundreds of applications to deal with,” said Dominick Bizzarro, RPh, global business manager for the healthcare division of InterSystems, speaking during a webinar hosted by the Health Information Management and Systems Society.

To allow for additional functionality and enhanced communication, dozens or hundreds of interfaces must be built both within and outside of an organization, according to Bizzarro. While this approach may have worked well enough in the fee-for-service era, new value-based reimbursement models will require higher degrees of interoperability.

Implementing an information system that fulfills basic requirements and taking a patchwork approach to clinical integration is no longer enough. Full interoperability is necessary to achieve the degree of communication and the analytical capabilities to make the improvements in care quality now required by law. 

EHR and other health IT tools were supposed improve healthcare productivity and efficiency to reduce costs, but several barriers still stand in the way, according to research published in the January issue of Health Affairs.

Arthur L. Kellermann, a RAND policy analyst, and Spencer S. Jones, a RAND information scientist, believe the potential is there. However, the design of implementation of health IT systems is preventing that potential from being realized.

The current generation of EHR systems fail to deliver in terms of interoperability, functioning “less as ‘ATM cards,’ allowing a patient or a provider to access needed health information anywhere at any time, than as ‘frequent flier cards’ intended to enforce brand loyalty to a particular healthcare system,” according to Kellerman and Jones. Information stored within an organization’s EHRs is often useless if a patient seeks out-of-network care. Even if another organization uses the same vendor, the degree of local customization often prevents the systems from communicating with one another.

Moving forward, Kellerman and Jones said efforts to facilitate savings through EHRs should focus on interoperability, patient-centeredness and ease of use, but larger adjustments to the healthcare system will need to be made.

“Fully interoperable, patient-centered and easy-to-use systems are necessary but insufficient to unlock the potential of health IT,” they concluded. “Ultimately, there is only so much that the government and vendors can do. Providers must do their part by reengineering existing process of care to take full advantage of the efficiencies offered by health IT. This revamping of healthcare delivery is unlikely to happen before payment models are realigned to favor value over volume.” 

Can you relate to these claims? Please share your experience.

Beth Walsh, editor

Clinical Innovation + Technology