I have posted a number of notes about how to promote EHR interoperability (see, for example: Revisiting EHR Interoperability; Standardized Content and Vendor Strategy; E-Prescribing Giant, SureScripts, Provides EHR Interoperability Solution). I have also stated that hospital executives constitute one of the major barriers to clinical information exchange among hospitals, although EHR vendors like Epic certainly deserve part of the blame. Hospital executives are not enthusiastic about medical record portability because it encourages patients to shop around for the best prices and quality. If hospital executives vociferously demanded this feature, EHR vendors would certainly be more responsive. Here is a quote from one of my notes on this topic from five years ago (see: Judith Faulkner, EMR Interoperability, and Washington IT Politics):
Hospital CEOs and CIOs have little interest or enthusiasm for multivendor interoperability, either within their hospitals or hospital systems or across the outside hospital systems that they compete with....They would thus rather have shrink-wrapped integration delivered by a vendor like Epic, the so-called "enterprise solution." Moreover, CEOs don't want to encourage broad patient and clinical data portability because it gives the payers (insurance companies and the federal government) a strategic advantage during negotiations about reimbursement.
A recent article makes this same point (see: How a Broken Medical Records System is Endangering America’s Health) and below is an excerpt from it:
[S]everal of the largest electronic health records systems have prioritized billing and regulatory reporting over other aspects of care. And many hospitals are still wedded to “fee for service” models, which reward doctors for pricey procedures and tests, rather than patient outcomes. The medical record vendors are helping these hospitals thrive in the status quo by driving up volumes of pricey procedures, policymakers say, and there is little incentive to share access to the records of those lucrative patients.“These fee-for-service hospitals are fighting tooth and nail to retain patients — and the vendors are responding to these needs,” said Dr. Bob Kocher, one of the key architects of the Affordable Care Act....“They [some hospitals] have not wanted features that make it easier to share information.” The inability of medical records to be easily electronically accessed in different places is a major failure in America’s health care system, experts like Kocher say, despite more than 20 years of political and health industry leaders advocating for streamlined system as a critically needed tool to improve patients’ health.
Even if fee-for-service were eliminated tomorrow, I don't think that most hospital execs would embrace EHR interoperability except perhaps when it works in their favor. This occurs for large teaching hospitals that receive referral cases. Having rapid access to the electronic records of those patients would be helpful. Even this could be a stretch, however, because interoperability can be technically challenging for hospitals and EHR alike. Hospitals won't pursue it actively, and pressure their EHR vendors, without some major incentives to do so. Some type of reimbursement hit might be the ticker. However, it's politically more palatable for the government to single out the vendors regarding the need for interoperability because the hospitals are such big employers and critical for the economic health of most cities. However, I think that hospital executive need to be invited to the interoperability party.