Do Hospitals Really Want Interoperable E-Health Records?

The New York Times yesterday published an op-ed piece about e-health records that was remarkable for its brevity and accuracy (see: Miles to Go on E-Health Records). Below is an excerpt from it with boldface emphasis mine:

The main impediment [to the wider deployment of EMRs] is money. Many hospitals simply do not have the capital to buy systems that can cost $20 million to $200 million, especially when so many are struggling to remain solvent. Hospitals also worry about high maintenance costs, an uncertain payoff on their investment, a lack of staff with adequate technical expertise and resistance from doctors....The ultimate goal is an “interoperable” system that would allow easy exchange of clinical data between hospitals and doctors. The modernization effort will have limited value if a mélange of different computer systems can’t talk to one another.

Hospital EMRs are extremely expensive and the estimate above for the cost of a single system is certainly in the ballpark for medium to large hospitals. Businesses of comparable size outside of healthcare would never consider, nor be able to pay, such high prices, even for a mission-critical system. An interesting question is why these systems are so expensive, particularly since many of them are rather antiquated. I can't point definitively point to any one factor but I would cite the following: few competing companies, a thin layer of buyers at the high end, the desire for extensive unique customization by each hospital client, and high customer vendor support costs.

However, let's turn to the issue of why EMRs from different hospitals "can't talk to each other." Let's call this system interoperability as noted above in the op-ed piece. Part of this problem is vendor-driven. As hospitals within cities and regions consolidate, they are faced with the daunting process of computer interoperability across the hospitals comprising the newly emerging multi-hospital health system. In such a setting, the dominant purchasing hospital commonly declares its EMR or LIS to be the winner and deploys it within the newly purchased hospital. Such an action always inflames an already simmering conflict within the now "integrated" system, creating winners and losers. However, more revenue is generated for the winning EMR vendor -- another payoff for non-compatibility.

What about interoperability across competing hospitals in a city or region? I have been involved with LISs and EMRs for decades. I have never seen a request for interoperability with information systems in competing hospitals in an RFP. This is quite simply a matter of market competition. Hospitals don't want portability of patient information with their competitors. If hospitals never asks for the expensive and complex interoperabilty of systems, given today's architecture of EMRs and LISs, how many vendors will try to force it down their throats?

Comments

[W.P. Fleischmann]

Benjamin Sasse at UT Austin recently described the market-driven impediments to interoperability this way: "if you want a sticky patient, why would you ever make a patient portable and available to your competitor?"

http://news.cnet.com/8301-13578_3-10199405-38.html

[Ole Eichhorn]

Bruce, this is a great point, I've wondered about this myself. Although "everyone" touts interoperability as a key goal, it seems interoperability between vendors delivers value, but interoperability between competing hospitals is not needed or even desired.