The major barriers to the easy exchange of health data among hospitals, EHR interoperability, have been erected by EHR vendors and hospital executives under a tacit collaboration agreement (see: Hospitals as a Major Barrier to the Pursuit of EHR Interoperability). A recent op-ed piece in the New York Times casts a harsh glare on who's behind this problem (see: Roadblocks to Sharing Medical Records). Below is an excerpt from it:
The ability to transfer electronic medical records from one doctor or hospital to another is essential to the smooth functioning of the health care system and to providing the best possible care to patients. Yet all too often these transfers are being blocked by developers of health information technology or greedy medical centers that refuse to send records to rival providers.
The tide has now turned with Congress attempting to enforce EHR interoperability but with industry observers commenting that one new legislative approach, not based on standards, is doomed to failure (see: Congress Can’t Solve the EHR Interoperability Problem). All of this attention on the need for clinical data exchange is beginning to have the desirable effect of shaming vendors into taking some minor steps in the right direction. For example, Epic is removing the fee for data exchange between its client and non-client hospitals (see: Epic to remove data sharing fee). Below is an excerpt from the article reporting this change:
Epic Systems has revealed that it will no longer charge a fee for data transfers between Epic customers and non-Epic customers through its Care Elsewhere module. "We're not going to charge for Care Everywhere for at least until 2020," CEO Judy Faulkner said. Up until now, clinical messages sent to an information exchange were priced at 20 cents apiece and incoming messages from a non-Epic system cost $2.35 for that patient for a year for unlimited messages, according to Faulkner. Faulkner said the company "thought it was cheaper" than its competitors, but found the fees irritated customers.
....Realistically, those fees only account for a tiny, tiny portion of Epic's revenue, so it seems smart to simply eliminate them, given what looks like increased federal heat. The ONC filed a Congressional report last week accusing "some healthcare providers and health IT developers" for "knowingly interfering with the exchange or use of electronic health information in ways that limit its availability."Plus, the company's competitors are already moving in that direction (Modern Healthcare's Joseph Conn called this an "interoperability price war".... Cerner CEO Neal Patterson said last year that the company would cover its customers' costs for participation in CommonWell Health Alliance through 2017, and athenahealth said it would do so indefinitely through the Alliance.
The data exchange fees required of non-Epic clients have been the subject of previous articles (see: Epic Systems feeling heat over interoperability). Here is a quote from one of them:
...[An] Epic spokesman said those fees are more than offset by the cost savings achieved from electronic records interchange...[An industry observer was skeptical about this.] “While I don't know for certain, I would be shocked if the average interface is only a few thousand dollars,” she said. She suspects that hospitals have to pay more to share data with its peers using different EHR systems. While interface fees are common across the EHR industry, some observers say Epic's leading role in the EHR market means it has a disproportionate negative effect on interoperability.
The fact that Epic has charged non-client hospitals for data exchanges illustrate a key fact about the attitude and culture of the company. It has previously viewed the ability to provide free interoperability as a "feature" for its clients rather than as a service for all patients. It has now reversed this policy in response to governmental pressure. For me, it's also refreshing that the NYT recognizes that hospital executives have been complicit with EHR vendors in this lack of easy sharing of hospital data. The availability of such data allows patients to shop hospitals for the lowest price and highest quality providers.