Are penalties the answer?

While the Office of the National Coordinator for Health IT (ONC) continues to talk about the high priority for interoperability, others are calling for more drastic action.

The Health IT Now Coalition is calling for action against the companies that have benefited from a lack of interoperability. The organization’s response stemmed from the findings of a report on interoperability challenges.

The report, Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value, found several technologies that could significantly improve health outcomes and lower costs for patients if only the lack of interoperability didn’t stand in their way. The RAND report specifically notes that some systems proactively block the sharing of clinical and administrative information for pecuniary business interests.

“As the Health IT Now Coalition has long stated, walled gardens and data blocking are obstacles to interoperability and transformation to a technology enabled health system,” said Joel White, executive director of the organization, in a release. “The RAND report reiterates what those in the health IT industry know well: Interoperability must be a priority if we truly want to improve patient outcomes, decrease costs and achieve a technology-enabled system.”

Meanwhile, another report found that despite the efforts toward interoperability, the current architecture for data exchange required by Meaningful Use Stage 2 does not allow for "robust" patient data sharing.

Researchers from the ONC-funded Substitutable Medical Applications and Reusable Technology (SMART) C-CDA Collaborative evaluated the Consolidated Clinical Document Architecture (C-CDA) for document exchange. EHRs must produce C-CDA documents to meet MU Stage 2 but the researchers found 11 areas of errors and variability that create barriers to interoperability in a study published in the Journal of the American Informatics Association (JAMIA).

Progress has been made since Stage 1, they wrote, but "any expectation that C-CDA documents could provide complete and consistently structured patient data is premature. Based on the scope of errors and heterogeneity observed, C-CDA documents produced from technologies in Stage 2 of MU will omit key clinical information and often require manual data reconciliation during exchange."

Is a more heavy-handed approach appropriate for the interoperability conundrum? What do you think?

Beth Walsh

Clinical Innovation + Technology editor