Feds dropped the ball on interoperability acceleration

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I eagerly awaited the announcement from the Office of the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services this week about how they would respond to their Request for Information on accelerating health information exchange and interoperability.

But I was rather disappointed when they unveiled ... not much of anything on Wednesday morning.

Sure, they announced some principles and strategies. They proposed a complex care management fee conditioned on electronic summary of care record exchange. They're using incentives, such as new reimbursement models and the Meaningful Use incentive program. And they're incorporating HIE into Medicaid and other state payment policies.   

But they're still allowing market forces, not regulation, to dictate how to share the data. Their strategy is to "encourage" interoperability and "voluntary" data sharing, and to "strengthen the business case for HIE across providers."

It is hard to do all of that, though, when the electronic health records can't easily interact with each other.

Take a look at the experience of my colleague Dan Bowman, who wrote this week about how the EHRs of his mother's providers could not interact with each other, leaving the providers to resort to care coordination ineffectively via fax and delaying treatment. That could have been avoided if we had national interoperability standards in place.

Consumers are not alone; many provider and vendor representatives also want national interoperability standards. They were practically begging CMS to mandate clear national interoperability standards at last week's eHealth Summit, lamenting during a panel on interoperability that the current standards were "semi-optional" and that the lack of standards is causing "tremendous waste." Ryan Bosch, chief medical information officer at Falls Church, Va.-based Inova Health System, told CMS that "we can't use the data unless it comes as a standard." FierceHealthIT Editorial Advisory Board member Indranil Ganguly, vice president and CIO for CentraState Medical Center in Freehold, N.J., warned that without standards "it's almost setting us up to fail."

Panel moderator Robert Anthony, deputy director of CMS' E-Health Standards and Services, pointed out that the government is trying to balance between government regulation and the marketplace.

But why here? Using the marketplace to create interoperability standards appears to be a slow, ineffective process, with uneven results. Is it a lack of resources? Concern about political backlash? Advance knowledge that National Coordinator for Health IT Farzad Mostashari was going to give notice and leave ONC, which may put the agency in flux?

Sometimes market forces should be allowed to shape an industry's development. But sometimes the government needs to step in and fill the void, especially when the industry itself is asking the government to do so. Too much variation here is impeding interoperability.

ONC and CMS had a golden opportunity to provide the industry with more direction, and dropped the ball.  

But it's not too late. I hope they reconsider on this one. - Marla (@MarlaHirsch)

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