Like scorpions, closed records cause paralysis

October 30, 2014 in Medical Technology

Take a step back from the challenges that surround health information technology (HIT) interoperability and you will recognize that market forces and a desperately fragmented health care system make hospitals and vendors act the way we do.

It calls to mind the fable of the scorpion and the frog, which is worth revisiting.

Wanting to cross a river, a scorpion spies a frog in the water and asks for a ride to the other side. Naturally afraid of being stung and killed, the frog hesitates, but is finally convinced by the scorpion’s argument that stinging the frog would be the end of them both in the dark flowing water. Midway across the river, the scorpion does indeed sting the frog, dooming them both. When the frog asks why as they sink beneath the surface of the water, the scorpion says, “Because I’m a scorpion.”

Compare what the fable has to say about innate characteristics with the current state of interoperability. The predominant proprietary HIT vendors know about the interoperability gap yet engage in prolonged foot-dragging on even basic data interfacing. Yes, healthcare IT is their business. No, interoperability is not in their nature.

A recent report by health research firm KLAS underscores this less-than-ideal reality: The federal government (they use our tax dollars, I must remind) has spent more than $25 billion on EHR adoption incentives and less than half of acute and ambulatory providers say their EHR is interoperable with other systems. Indeed, only 20 percent of providers are “optimistic” about vendor collaboration initiatives like the Cerner-led Commonwell Health Alliance.

The problem (apologies for beating a dead horse) is with the business model. The prevailing proprietary HIT business model is based on making the vendor the sole source of technology. Complexity of data sharing helps create a vendor lock scenario in which opening up the records is bad for business.

This situation has not gone unnoticed in Congress. As widely reported this past summer, U.S. Rep. Phil Gingrey (R-Ga.), a physician and member of the House Energy and Commerce Committee, singled out Epic for criticism, quoting a RAND report that asserts Epic provides “closed records.”

With incentives focused on driving interoperability, Gingrey asked the obvious question:

“Is the government getting its money’s worth? It may be time for the committee to take a closer look at the practices of vendor companies in this space, given the possibility that fraud may be perpetrated on the American taxpayer.”

Of course Epic founder and CEO Judy Faulkner counters that her system is actually open and interoperable. In a September interview with the New York Times, Faulkner explained that Epic’s Care Everywhere solution connects hospitals nationwide. What she did not say is that the company created this bridge to compensate for the complexity of Epic implementations, which are so unique that two distinct Epic systems cannot plug and play. Uniqueness drives complexity and dependence.

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