Some health IT experts criticize the Government Accountability Office report for ‘incomplete research’ and failure to focus on ‘person-centered interoperability’

Several years after paying billions of incentive dollars to thousands of hospitals and physicians to encourage adoption of electronic health records (EHRs), federal officials remain frustrated at the lack of interoperability among the competing EHR systems. This is a problem recognized by clinical laboratories that must create and maintain interfaces between their laboratory information systems (LISs) and the EHRs of their client physicians.

Frustration over this situation motivated Lamar Alexander (R-TN), Senate Health, Education, Labor and Pensions Committee chairman, along with four other U.S. Senate Committee Chairman, to request that the General Accountability Office (GAO) study the problem and report its findings. The GAO released its report last September in a publication: “Nonfederal Efforts to Help Achieve Health Information Interoperability.”

The GAO’s investigators outlined five barriers to EHR interoperability. They also suggested that meaningful use (MU) requirements present a roadblock to information sharing.

Congress Requests Review on Progress of EHR Interoperability Initiatives

At the request of Congress, the GAO was asked to examine nonfederal efforts “to develop infrastructure needed to support nationwide interoperability of healthcare information.” Congress was interested to learn what private-sector initiatives were doing to encourage and enable greater interoperability.

The GAO report focused on 18 ongoing initiatives to drive interoperability:

• Seven tied to addressing technical issues such as the uniform implementation of standards for EHR and other health IT systems;

• Five focused on less technical products or services to facilitate EHR interoperability such as promoting agreements between providers to improve the exchange of health information; and

• Six aimed at developing networks to facilitate EHR interoperability by connecting EHR systems or providers through a technical service that enables the exchange of information.

Among the 18 programs reviewed by the GAO were the:

Argonaut Project;
California Association of Health Information Exchanges;
CommonWell Health Alliance;
eHealth Initiative (eHI)
HealthBridge; and the
Statewide Health Information Network of New York.

Report Highlights Five Specific Challenges to EHR Interoperability

Stakeholders and initiative representatives pointed to five challenges to achieving EHR interoperability:

1. Insufficiencies in health data standards;
2. Variation in state privacy rules;
3. Accurately matching patients’ health records;
4. Costs associated with interoperability; and
5. Need for governance and trust among the entities.

Some participants in the GAO’s study also suggested that changes to the Centers for Medicare & Medicaid Services’ (CMS’) EHR Incentive Programs—including pausing or stopping the meaningful use program—could accelerate progress toward achieving interoperability goals.

“While eight initiative representatives we spoke with told us that the EHR Incentive Programs have increased adoption of EHRs, representatives from five initiatives suggested pausing or stopping the programs. Representatives from 10 of the initiatives noted that efforts to meet the programs’ requirements divert resources and attention from other efforts to enable interoperability,” the report states.

Representatives from 10 of the initiatives told the GAO that the criteria currently used to certify EHR systems under the EHR Incentive Programs are not sufficient for achieving interoperability, and representatives from three initiatives suggested amending the criteria to focus on testing EHR systems’ ability to interoperate. While stressing the need for EHR systems to improve in ways that would allow healthcare providers to find value in interoperability, representatives said they also expect the transition away from fee-for-service reimbursement and toward value-based payment would encourage more physicians to want to share information.

GAO Report Criticized as ‘Incomplete” and ‘Lazy’ By Some IT Experts

The GAO report, however, quickly drew criticism from some health IT experts. HealthcareIT News reported that in an Oct. 1, 2015, tweet Jacob Reider, MD, Chief Strategy Officer at Kyron, and a former Deputy National Coordinator and Chief Medical Officer at The Office of the National Coordinator for Health Information Technology (ONC), labeled the GAO findings: “Incomplete research + lazy reporting propagates political fiction. Sad.”

Arien Malec, Vice President of Data Platform Solutions for RelayHealth sees the the Government Accountability Office report on nonfederal efforts to improve EHR interoperability as “a missed opportunity to get deeper into driving what would be required for true person-centered interoperability.” (Photo copyright: Healthcare Informatics.)

Arien Malec, Vice President of Data Platform Solutions for RelayHealth sees the the Government Accountability Office report on nonfederal efforts to improve EHR interoperability as “a missed opportunity to get deeper into driving what would be required for true person-centered interoperability.” (Photo copyright: Healthcare Informatics.)

In an interview with Healthcare Informatics Magazine, Arien Malec, Vice President of Data Platform Solutions for RelayHealth, offered his critique of the GAO’s findings.

Rather than focusing solely on EHR-to-EHR interoperability, Malec argues the GAO report should have included initiatives advancing person-centered interoperability, which is the flow of patient information between all systems, regardless of technology or platform.

“This person-centered perspective is the view that the ONC Interoperability Roadmap also has as its definition,” he told Healthcare Informatics. “You’re starting to see some consensus around interoperability beyond EHRs and interfaces, and more towards what information is required to provide optimal care.”

Dark Daily reported last fall that the House had passed one bill intended to encourage interoperability. It would not be a surprise if some members of the Senate crafted their own version of law to accomplish interoperability. (See Dark Daily, “Because It Remains Tough to Achieve Interoperability among EHRs, Congress is Proposing Legislation to Resolve That Issue in Ways That May Help Medical Laboratories, ” October 23, 2015.)

Chief Technology Officers for clinical laboratories and pathology groups may want to read the GAO’s report for themselves in order to understand everything that the federal agency reported to Congress. This document may play an important role in shaping any further legislation.

—Andrea Downing Peck

Related Information:

Health IT Expert Urges Providers, Venders to Action for ‘Person-Centered Interoperability’

GAO Report: MU Requirements Impede EHR Interoperability

GAO Report: Government’s Electronic Health Records Program Actually Slowing Down Data Sharing Between Doctors and Hospitals

Electronic Health Records: Nonfederal Efforts to Help Achieve Health Information Interoperability

GAO: 5 Barriers to Interoperability

Connecting Health and Care for the Nation

Improving Health Through Interoperability and Information Sharing

Because It Remains Tough to Achieve Interoperability among EHRs, Congress is Proposing Legislation to Resolve That Issue in Ways That May Help Medical Laboratories

HIE Use Rises along with Adoption of EHRs, but Full Interoperability Remains Elusive for Hospitals, Physicians, Clinical Labs, and Pathology Groups

ONC Releases Final Rule for Stage 3 Meaningful Use: What Most Affects Clinical Laboratories and Anatomic Pathology Groups