BioPharma: Why Care

HIT Perspectives Biopharma Insights – November 2015

Why Care About the EHR Interoperability Brouhaha?

By Brian Bamberger, Life Sciences Practice Lead

Do electronic health records (EHRs) talk to each other? Are they sufficiently interoperable? It depends on whom you ask. Providers and EHR vendors have different perspectives, and they have been pitted against each other in the press and on Capitol Hill over the dimensions of the issue. So, why should pharmaceutical manufacturers care? It all comes down to sharing patient-related data to improve the patient experience, quality of care and build data sets that can assist research.

The issue of EHR interoperability has been brewing for some time. It came to the forefront last April, when the federal Office of the National Coordinator for Health Information Technology (ONC) released a report finding some health information technology (health IT) vendors and health care providers are intentionally blocking the sharing of patient information. Sharply critical of EHR vendors, the report alleges that certain vendors create a climate ripe for information blocking through business practices and pricing. Lately, the issue seems to have taken on a life of its own.

We have a two-part take on the topic. The first part is that EHRs are interoperable. Their ability to ‘talk’ to each other in a standardized way has increased significantly in recent years as a result of the EHR certification requirements within meaningful use (MU), the government’s incentive mandate. In order to be eligible for incentives, physicians must use EHRs that are MU certified. The technical infrastructure needed for health data exchange also has expanded and improved. That said, could interoperability be better? Of course, and it continues to be a work in progress with new technologies, such as Fast Healthcare Interoperability Resources (FHIR), being adopted. In fact, a group of 12 major EHR vendors has agreed to adopt a set of metrics and engage in ongoing reporting to help assess the country’s progress toward achieving interoperability.

According to a recent report from KLAS, physicians overwhelmingly report their vendors to be willing to help them share information. There is a pervasive perception, however, that vendors’ business and revenue models interfere with data sharing. Physicians chafe at the reality that interoperability requires software licenses and connectivity fees to the health information exchange offering. But license and technical support fees are legitimate – and legal – ways in which vendors stay in business; they are not designed for the blocking of information. Sensitive to the issue, vendors are revisiting related revenue models to design a price structure that does not make interoperability cost prohibitive.

What about the providers? Again, it all comes down to business models and revenue. The KLAS report confirms what we’ve known all along: integrated delivery networks (IDNs) and physicians have been reluctant to share patient records with rival providers in order to control referrals, enhance market dominance and keep reimbursements within their own organizations. As the transition occurs from fee-for-service to quality-based reimbursement, business reasons will emerge for providers to share patient data –¬†more informed diagnoses, improved care coordination, better outcomes, reduced costs and elimination of duplicative testing. But in the meantime, IDNs and physicians will be reluctant to share patient data.

Why should pharmaceutical manufacturers care about data blocking? Or put another way, why should pharmaceutical manufacturers care about providers refusing to share patient data? Again, it all comes down to business models and revenues. Sharing patient data will make coordination of care between primary care providers and specialists easier. Exchanging information connects the health care system for the benefit of patients by reducing repeated questions and duplicative tests. Research entities will also benefit by having more complete data to power medical advances easier and ultimately save lives by helping researchers investigate drug-related side effects or the effectiveness of new treatments on patients. Sharing patient information will also aid in personalizing medicine, using genomes and biologics, as well as help providers connect patients with new therapies and clinical trials.

All of this has a direct impact on how pharmaceutical companies do business. Point-of-Care Partners is closely monitoring the information blocking issue. Let us keep you up-do-date on developments and impacts.