Should ONC Decertify EHRs That Block Interoperability?

Interoperability is at the top of the list of industry-wide health IT goals, yet commercial EHR offerings with expensive add-on modules, proprietary data standards, and black-box systems that perpetuate data silos continue to be used to meet important goals like meaningful use attestation.  In the wake of a RAND Corporation report calling out a lack of interoperability as a significant barrier in EHR adoption and an ONC roadmap targeting interoperability by 2024, the Health IT Now Coalition poses an interesting question: why are EHRs that don’t meet interoperability goals still on the list of certified meaningful use technologies?

Healthcare organizations have been developing electronic health records since the 1970s, notes the RAND report Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value, but a number of systems developed proprietary, in-house technologies to meet HMO quality and outcome measures in the 1980s, leading to a patchwork of legacy systems, bolted-on modules, and on-the-fly programs by the time commercial EHR developers and government incentives for technology adoption started to develop in earnest by the turn of the century.

Despite the HITECH Act and the EHR Incentive Programs, adoption has remained slow as financial and productivity concerns continue to weigh on providers’ minds, leading HHS to institute “watered down” interoperability requirements, RAND says, to sweeten the pot and get providers to adopt anything at all.  “By subsidizing ‘where the industry is’ rather than where it needed to go, HHS rule-makers allowed hospitals and healthcare providers to use billions in federal subsidies to purchase EHRs that did not have the level of connectivity envisioned by the authors of the HITECH Act,” the report says.  “The result was far short of the ‘interoperable and interconnected’ network that the RAND team envisioned in its 2005 analysis of the benefits of EHRs.”...