August 14th, 2019
Imagine if instead of creating an interstate highway system, our country had instead relied on cities to build their own roads, without standardized mechanisms for connecting the roads to each other? What if instead of highways being a public good maintained by the government, cities had outsourced road building to different private construction companies, who kept the roads disconnected as a ploy to expand their market share?
It sounds like a crazy scenario, but this is how we have built our health information highway. Rather than create a national network of health information exchange on a publicly-maintained electronic medical record system, in 2009 the government endorsed a “regional” approach for building EMRs. As a result, in many regions of the country it is no easier to share medical information than it was a decade ago.
Health care interoperability is the topic of a new Health Affairs blog by Dr. Michael Hochman, associate professor of clinical medicine and director of the USC Gehr Family Center for Health Systems Science; Dr. Edmondo J. Robinson, chief transformation officer and senior vice president at the Christiana Care Health System, and associate professor of medicine at Thomas Jefferson University; and Judith Garber, Health Policy and Communications Fellow at the Lown Institute.
Hochman et al. discuss what went wrong with health care information exchange, and what keeps preventing the shared goal of seamless, safe information exchange. Among the reasons are the lack of a unified health information exchange initiative, and lack of incentives for EMR vendors to participate in these initiatives. Getting private EMR companies to get on board with sharing information isn’t easy. According to David Blumenthal, the inaugural national coordinator for health information technology, asking health care leaders to exchange data is like “asking Amazon to share their data with Walmart.”
To fix this problem, Hochman et al propose a radical departure from our current fragmented system — the creation of a national health information exchange public option, to which any health care system can opt in. This would require grappling with issues of governance, funding, oversight, and privacy concerns. But these are issues that all health information exchanges must deal with; the true challenge to change will be political, not practical.
For more, read the full blog on Health Affairs!