Interoperability is front and center, again. Stage 1 of HITECH was about health records for doctors. Stage 2 is about interoperability. The President’s Council of Advisors on Science and Technology (PCAST) report is all about interoperability. At a recent state medical society meeting, the most animated questions by physicians to Dr. Blumenthal were about the lack of interoperability in electronic health records.
While HITECH is designed to regulate the behavior of technology vendors, it is struggling to encourage doctors to accept the result. Growing interest in ACOs may, at last, drive doctors to demand effective interoperability, and using the patient as a principal or intermediary can jump-start the clinical integration they seek.
For more than 5 years, interoperability has been approached from the perspective of doctors and hospitals. The results speak for themselves. As we process the innovations proposed by PCAST and consider the specifics of Stage 2 regulations, it’s time to put patients first and technology second by giving patients (and their designated agents) convenient access to their health records in their choice of electronic formats including Blue Button, CCR and CDA. Market forces will take care of the rest. Experience with Blue Button and the Direct Project shows that patient-centered and secure, directed exchange avoid the privacy and policy issues that delay technological approaches to interoperability.
There are three lines of argument against putting the patient first in information sharing: anxiety or other harm to the patient; hardship for the clinician, which will delay adoption of technology; and unwarranted privacy fears, which will hamper research. This post will not argue these complex issues. Simply consider that none of these are settled fact. A change in physician attitude toward interoperability could preempt the debate and lead to rapid progress.
Are physicians actually starting to want interoperability? A Perspective in the New England Journal of Medicine, Physicians versus Hospitals as Leaders of Accountable Care Organizations – http://www.nejm.org/doi/full/10.1056/NEJMp1011712 – argues that “Holding off on creating ACOs is likely to be a bad long-term strategy for physicians.”
Once the data starts to flow, payment reform such as ACOs will bring pressure from both doctors and hospitals to process incoming documents, and industry will implement effective standards without heavy-handed technology regulations.
Putting the patient first works by introducing competition for interoperability solutions between provider and patient-oriented vendors. ONC will still need to regulate some technology but, as PCAST suggests, health information exchange will take a different tack. Stage 2 would do well to give patients quick access to electronic data in their choice of formats and, at least, insist that providers are aware of and acknowledge incoming electronic documents from their patients.
Adrian Gropper, MD, is a founder of MedCommons, with roots in patient-controlled and patient-centered health records that go back to MIT’s Guardian Angel project. AMICAS, a more recent radiology-focused venture, pioneered the clinical use of Web browsers and protocols. Adrian is driven by the vision of doctors and patients collaborating around shared health records on the Web.