Stepping Up to the Plate
Why Health IT Vendors Need to Do More to Meet the Interoperability Requirements of Meaningful Use
By Mark Heaney, CEO, Get Real Health
Recently I joined other health IT vendors to testify before the Office of the National Coordinator for Health IT’s Health Information Technology Policy Committee about interoperability and health information exchange. As all of us who work in this industry know, interoperability is a key requirement of Meaningful Use (MU) certification, and with good reason: the easier it is for providers to exchange patient health information electronically, the more cost savings the system will see and the better care patients will receive.
MU is fundamentally successful because it pushes provider organizations to implement a technology many of them have been wanting to implement for years, but, without a mandate, couldn’t prioritize. With MU requirements looming, that’s changing. Yet it’s important to note that, currently, there’s really no “stick” forcing hospitals and other providers to implement health information exchange systems—but they’re doing it anyway. That’s because they recognize the non-regulatory benefits of adopting MU practices even before they’re required, namely better patient care.
But our industry is falling short when it comes to meeting their needs.
In too many cases, EMR vendors are offering clients MU-certified products that don’t actually conform to interoperability requirements. Of course, fostering interoperability is no easy task. In my career prior to entering healthcare IT, I designed and implemented financial services, e-mail and network communication systems. What I’ve learned is that creating interoperability in healthcare IT is vastly more difficult than it is in these other systems. First, healthcare data is much more complex and varied. Financial systems have a finite, simple data set: dollars, accounts, trade symbols, transaction types, etc., while in healthcare, there are hundreds of types of data and dozens of vocabularies for defining the meaning of data.
Second, healthcare IT systems are customized much more for each customer than are these other systems. Virtually every large provider organization has tailored their EMR to their own specific workflow and informatics requirements. This means that individual instances of EMRs may not capture all the fields required for meaningful data exchange. There are good historical reasons for allowing healthcare providers the flexibility to adapt systems to their specific needs. No clear historical analog exists for forcing interoperability between systems with this level of variance and complexity. It’s like trying to get all of the Enterprise Resource Planning, Business Intelligence, or supply chain systems within all of the companies in an industry to work together.
For these reasons, the current certification regime based on “clean room” testing—where you set up an idealized reference implementation of a technology and see if it can produce the required output—is insufficient to create real-world interoperability. Due to the variances and customization within individual provider organizations, the only true interoperability test is in the real world. Therefore, vendors who want the benefit of being certified solutions need to prove that they can do so “in the wild.”
This is where EMR vendors are falling short. We’re seeing provider organizations adopt MU-certified tools that “passed” the required tests in a clean and controlled environment, yet when they’re installed in the real-world system, they’re failing, forcing the provider organizations to seek patches and work-arounds to meet the interoperability requirement.
As an industry, we owe it to our clients to be more proactive where interoperability is concerned. We need to go beyond checking the MU-certified box and handing it over to healthcare providers as “good enough.” Instead, when a client is getting ready to test for MU, we need to do a preparation plan for them, or, at the very least, be prepared to react quickly and get the documents ready to be transferred to wherever the client sends them. If our products meet the specifications and pass the test, we can walk away with our heads held high, knowing that we’ve done our job.
ONC has done its part; they’ve gotten the ball rolling. Hospitals are trying as hard as they can with all the current challenges. But we as a vendor community need to step up to the plate where interoperability is concerned. We need to proactively test with other systems and proactively engage with our customers. Simply put, we can’t leave our clients surprised when the “solution” we sold them doesn’t work.
As we move forward with MU, it’s important to remember that Meaningful Use is not just a proper noun; it’s a description of what we’re trying to accomplish. We need to find meaningful ways that we can exchange information to provide real-world benefits to healthcare providers and patients as a whole. Vendors can’t be in it simply to meet a certification. We need to be doing it because we want to improve health care and cut health care costs. We need to do better, and I feel confident that we can.