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Attaining full interoperability of electronic healthcare systems is a challenge that transcends technology, argues Dr. Julia Adler-Milstein, associate professor at the University of Michigan’s School of Information, School of Public Health.
Writing in NEJM Catalyst, an online publication of the New England Journal of Medicine, Adler-Milstein acknowledges that “health information is hard. If it were easy, we would have it, or at least have more of it, by now.”
Compounding the inevitable technology issues, she says, is the need to unite stakeholders and create an organizational framework that supports interoperability goals.
“As we have seen in other industries, interoperability requires all parties to adopt certain governance and trust principles, and to create business agreements and highly detailed guides for implementing standards,” Adler-Milstein writes. “The unique confidentiality issues surrounding health data also require the involvement of lawmakers and regulators.”
Though her article is titled “Moving Past the EHR Interoperability Blame Game,” Adler-Milstein cites in some detail how policymakers, EHR vendors, and providers each have impeded progress toward widespread healthcare interoperability.
The root of the problem is that policymakers failed to create regulatory incentives to promote interoperability that were strong enough to offset market incentives, such as vendors wanting to lock in customers by engaging in information blocking. EHR vendors thus lacked any incentives to prioritize interoperability, according to Adler-Milstein.
And while many providers have opted to pursue interoperability because they believe it will help them deliver better care to patients, Adler-Milstein writes that “some provider organizations let competitive pressures drive interoperability decisions (including not demanding robust interoperability from their vendors).”
“It is hard to justify investing in a complicated, expensive capability that also poses a strategic risk — a double whammy,” she says.
Adler-Milstein concludes that the onus is on policymakers to move the interoperability needle.
“Only policymakers have a clear, strong interest in promoting interoperability,” she says. “Therefore, it is up to them to ensure that robust, cross-vendor interoperability is a stay-in-business issue for EHR vendors and providers.”
You can read the entire article here.