In response to a recent note about Epic's new lobbying initiative (see: Epic Retains Lobbying Firm to Improve Its Interoperability Image on Capital Hill). Chris Brancato submitted the comment copied below. I found it interesting and decided to promote it to the level of a blog note. Here is what he had to say:
Interoperability is so amorphic a term that most people on the Hill will just not get what that means and how the meaning is often manipulated. It's akin to saying you're HIPAA compliant, whatever that means. Makes for good marketing though. Epic, and every other vendor on the planet, is selling nothing but this: "Health IT would be interoperable if you all just did it our way". Those of us who've trudged through implementations know that just ain't so even if you use the exact same product. What we really mean to say is that the content is predictable. I, as a clinician, can reasonably predict that of you send me what we call a patient summary record, I'll know what to expect it would contain with little or no variation. Take the multiple and almost infinite iterations of the document we call discharge summary. When I receive one from a hospital and another one from a different hospital, one would reasonable expect that they would contain the same phenotypes of data and data elements. And you'd be 100% incorrect....The heart of interoperabilty is standardized content and definition. Moving the data is in its essence pretty darn easy. Knowing what I'm going to get when I need it is something totally different. The rest of the arguments about interoperability as simply spurious noise.
I agree with Chris that an essential element for interoperability is standardized content and definition. However, I would refer to this as a necessary but insufficient condition for EHR interoperability. Also necessary to achieve the frictionless exchange of hospital-to-hospital clinical information is the absence of barriers across EHRs from different vendors. An article on interoperability has just been published by the New York Times (see: Digital Medical Records Become Common, but Sharing Remains Challenging). Below is an excerpt from it:
There is no evidence that...[any one of the various major EHR companies] does a better or worse job of sharing information. But Epic and its enigmatic founder, Judith R. Faulkner, are being denounced by those who say its empire has been built with towering walls, deliberately built not to share patient information with competing systems. Almost 18 months after an Epic system was installed at UnityPoint Health-St. Luke’s hospital in Sioux City, Iowa, physicians there still cannot transmit a patient care document to doctors two miles south at Mercy Medical Center, which uses a system made by another major player in the field, the Cerner Corporation. Where interconnectivity between systems does occur, it often happens with steep upfront connecting charges or recurring fees, creating what some see as a digital divide between large hospital systems that have the money and technical personnel and small, rural hospitals or physician practices that are overwhelmed, financially and technologically.
It sounds like the NYT is now singing a slightly different tune when compared to the very laudatory piece about Epic and Faulkner that was published in January, 2012 (see: More on Epic's (Non)-Interoperability and the Recent NYT Puff Piece). I had commented in a blog note in 2011 that Faulkner was appointed to the federal Health Information Technology Policy Committee with one major goal of promoting EHR interoperability. This despite the company's lack of enthusiasm for this key function of EHRs (see: Judith Faulkner, EMR Interoperability, and Washington IT Politics). This committee appointment reflects not only the position of Epic as one of the key players in the EHR market but also the enthusiasm of Wisconsin congressmen for the company.
With regard to interconnectivity fees, this is another facet of the barriers placed by a vendor like Epic to favor their own hospital client base and to spur sales. I don't personally think that fees should be charged for the exchange of patient information. This is contrary to the frictionless exchange of patient information that is so critical. If fees are charged, they should probably be borne by the larger hospitals in order to avoid the digital divide referred to in the NYT piece quoted above. Moreover, the larger hospitals derive greater benefits from the sharing of clinical information because the direction of patient referrals (and the need for the electronic review of patient records) is toward these larger and more complex facilities.