ONC's 10-year interoperability strategy open for debate

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The Office of the National Coordinator for Health IT recently released its 10-year strategy for achieving national interoperable health IT infrastructure.

"We have heard loudly and clearly that interoperability is national priority," wrote ONC head Karen DeSalvo, MD, MPH, MSc, in a blog about the strategy on Health IT Buzz. "We also see that there is a tremendous opportunity to move swiftly now."

But is this “moving swiftly”? Many stakeholders expressed surprise that the ONC needs that much time but others say it is a reasonable timeframe. It also reflects the “enormity and complexity of the problem,” says Howard Nearman, MD, chairman of the department of anesthesiology and preoperative medicine at University Hospitals’ Case Medical Center in Cleveland.

The Meaningful Use program “unleashed a wild animal and now they’re trying to tame it. There are all these EHRs out there but none talk to each other and nobody knows how to get them to talk to each other.”

Another issue is that after providers spent so much money purchasing and installing the EHR systems, they don’t have the money to spend more to solve the interoperability problem.

Donald Voltz, MD, anesthesiologist at Cleveland’s Aultman Hospital, agrees. “It’s clear from the ONC’s publication that they understand what the issue is but if you read between the lines, it’s also pretty clear that they’re not clear on what the solution is.” EHRs were built as databases, he says, that can store and efficiently retrieve information, not take it to the next level of communication as part of a record. “We really don’t need a system that’s just going to let people aggregate data and then find a place to dump information and think that’s going to fix the problem. We’re going to have problems with duplicates and difficulty validating which data are appropriate.”

The unspecific ONC plan is “very deflating,” Voltz acknowledges, and ties into the growing feeling of frustration physicians feel toward health IT. “We have been so hobbled in the sense of how we take care of patients. We’re spending a significant amount of time searching for data and then entering our own version. It’s one thing after another in frustration.”

EHRs are behemoth products that require significant resources for upgrades, says Voltz. “When I work with an EMR, I’m so far down in the weeds. We’re forced to navigate deep into the technology. It’s a real disservice. It’s too complex for us to interact with. It’s like throwing a basic user into a Unix command line. It’s ridiculous.”

A more detailed 10-year plan would be more accepted by stakeholders, he says, but the ONC doesn’t have a good history of “rollout that suggests that they found the problem, they understand the problem and they’re going to fix it.”

Despite calls for interoperability, Voltz says EMR vendors don’t have a business case to share information. “They don’t want to support outside bodies. They’re trying to get business from each other.”

Doctors often aren’t included in the development of these tools “we are so intimately involved with. I’m hoping some of that changes.” Many of the promises made by vendors when selling systems to hospitals never came to pass, he adds. “Once the purchase is made, it’s very difficult to go back and get it to do the things you want it to do and once the money is invested they’re not willing to rip and replace.”