Open Secret: The Threat to Interoperability

By Jim Tate, EMR Advocate
Twitter: @jimtate, eMail:
Host of The Tate Chronicles#TateDispatches

The path to interoperability of healthcare data is proving to be a long and winding road. “The right data, at the right place, at the right time” has become the mantra. The emergence of TEFCA (Trusted Exchange Framework and Common Agreement) is the most recent and far-reaching effort to achieve cross platform access to healthcare data.

Six years in the making, TEFCA is being born with the greatest of hope and anticipation. Yet, underneath all the fireworks and hoopla a threat exists, and the shame is that this threat is predictable and fixable.

In the past we have seen two great steps forward in the adoption and use of Certified Electronic Records technology. Massive government spending provided the necessary funding and stimulation for the adoption and appropriate use of this technology. The HITECH Act in 2009 included legislation that offered up to $44,000 for the adoption of a certified EHR by Medicare providers and $63,750 for Medicaid providers. The Act also created 62 Regional Extension Centers to support, educate, and provide guidance to the healthcare community. All this was delivered without cost to providers. No such significant effort is underway to promote interoperability.

The current state of interoperability has demonstrated that the technology is way ahead of use. For years there has been a requirement for a Certified EHR to be able to create and securely send Consolidated Clinical Document Architecture (CCDA) files but how many providers have ever used that functionality? We have built a highway but no one wants to drive. Hell, no one even sees the advantage of driving.

Under the coming TEFCA network-of-networks the ability of providers to easily access patient records may well be within reach across the healthcare infrastructure. But without education, training, and incentives the success of TEFCA is threatened. There is a minor carrot being offered in terms of the MACRA/MIPS objective ‘Enabling Exchange Under the TEFCA’ but this is not enough.

The inadequate funding for education and incentives for interoperability in general, and TEFCA in specific, is the greatest threat to healthcare data interoperability. It is not too late to fix this. Failing to do so will hamper what everyone professes to desire, true and seamless exchange of data.

Technology without subsequent education and training is a recipe for failure. We are taking the wrong path in a darkened wood. Here’s hoping the Lords of Policy and Funding have a few cards up their sleeves to address this before a golden opportunity is lost.