The big news at HIMSS13 was the unveiling of CommonWell (Cerner, McKesson, Allscripts, athenahealth, Greenway and RelayHealth) to “get the ball rolling” on data exchange across disparate technologies. The shame is that another program with opaque governance by the largest incumbents in health IT is being passed off as progress. The missed opportunity is to answer the call for patient engagement and the frustrations of physicians with EHRs and reverse the institutional control over the physician-patient relationship. Physicians take an oath to put their patient’s interest above all others while in reality we are manipulated to participate in massive amounts of unwarranted care.
There’s a link between healthcare costs and health IT. The past months have seen frustration with this manipulation by industry hit the public media like never before. Early this year, National Coordinator for Health Information Technology Farzad Mostashari, MD, called for “moral and right” action on the part of some EHR vendors, particularly when it comes to data lock-in and pricing transparency. On February 19, a front page article in the New York Times exposed the tactics of some of the founding members of CommonWell in grabbing much of the $19 Billion of health IT incentives while consolidating the industry and locking out startups and innovators. That same week, Time magazine’s cover story is a special report on health care costs and analyzes how the US wastes $750 Billion a year and what that means to patients. To round things out, the March issue of Health Affairs, published a survey showing that “the average physician would lose $43,743 over five years” as a result of EHR adoption while the financial benefits go to the vendors and the larger institutions.
CommonWell is just IHE 2.0. IHE stands for Integrating the Healthcare Enterprise, a decade-long project of HIMSS designed to preserve a business model where neither physicians nor patients buy anything (the industry represented in HIMSS serves institutions almost exclusively) and interface costs account for some 60% of revenues. 60% interface costs should be compared to pre-IHE medical interfaces such as DICOM and the universal Internet business model where interfaces are free and only services are billed.
IHE is a governance mechanism for interoperability practices that is managed by the largest EHR vendors and has brought us a decade of stagnation, consolidation, vendor lock-in, and physician and patient frustration. CommonWell is a governance mechanism for interoperability that is managed by the same EHR vendors under a friendly new name.
The specifics of CommonWell are still undocumented. From what I can tell at HIMSS13, the focus will continue to be on institutional control of the physician-patient relationship, coercive patient ID practices, information silos defined by institutional concepts of what patients trust, and protocols designed to perpetuate the vendor lock-in business model.
So let me summarize what I see so far at HIMSS13. Take $10 to $20 Billion of taxpayer money (depending on how HHS will handle remaining EHR interface regulations and privacy governance issues), use it to consolidate small practices and entrepreneurs out of business then orchestrate rent-seeking behavior on 20% of the US economy to extract value from our own data that we can’t access ourselves.
It’s not easy to waste $750 Billion a year by overcharging and providing unwarranted care but coordinated efforts such as CommonWell look like they will continue the health IT industry’s contribution. It’s easy for CommonWell to prove me wrong by announcing that the data liquidity they propose means all interfaces from federally subsidized EHRs will be free and under the control of individual physicians and their patients.
Adrian Gropper, MD is Chief Technical Officer of Patient Privacy Rights and participates in Blue Button+, Direct secure messaging governance efforts and the evolution of patient-directed health information exchange.