A lot has been discussed about MACRA lately and the potential impact on physicians and the EHR marketplace. The post-mortem analysis about the Meaningful Use legislation has primarily focused on the critique that there were too many metrics for physicians to manage to prove they were using the EHR’s in a meaningful way. Although this is a reasonable conclusion, I would argue stepping back even further and seeing what was really the whole point of Meaningful Use in the first place to get a better assessment of the damage done.
The good intention, I believed, was to harness the technology of EHRs (by being digital, as opposed to paper), so that these EHR systems were to be able to talk to each other. This is not a foreign concept as there are so many examples today of how digital has transformed the ability for data to go from one container to another (e-mail, websites, social media) and even now with single sign-on solutions, current technologies (RESTful APIs, HTTPS, oAUTH) makes data transfers relatively trivial and secure.
It is laughable to me now that we are nowhere near where we should be to get true interoperability given the existence of these well documented and proven technologies. The framework of the current crop of EHR’s with the largest market share is not focused about interoperability, but it’s about a monolithic, siloed entity that does not care whether you practice in a hospital, outpatient clinic, mental health office, child abuse evaluation center, nursing home, dentist office, or a direct primary care office. Never mind that these EHR’s has 95% of everything a health care provider doesn’t need to use or see and that he or she has to use extra mental capacity to filter all of it out just to make it work way that works for them. Never mind that these EHR’s will still not have the ability to automatically get the most up-to-date information about the patient you are taking care of in front of you because there is a pretty good chance that this patient may have gone to a different clinic or hospital, added or deleted a medication, allergy, or diagnosis without your knowledge, and it has not been reconciled with your EHR.
Effectively, these EHR’s are just an expensive, digital form of paper except it doesn’t work any better than the old-fashioned paper. At least with paper, you can organize your chart YOUR way. At least with paper prescriptions, patients can provide a signed physician prescription to different pharmacies if they want to price shop. No wonder most doctors are disgusted and frustrated. Doctors and patients are now left to choose and use only a handful of non-useful tools now that the EHR marketplace has been decimated to only a few big players thanks to Meaningful Use.
What’s next? In general, these few big EHR players aim to increase their profit and market share by doing the walled-garden, monolithic, sliloed approach to interoperability. Think about it…it wouldn’t make any sense for them from a business standpoint to share a standard interface to talk to another big vendor EHR if they can do anything about it. They will delay, delay, and delay to prevent interoperability from ever seeing the light of day. In the meantime, they hope to convince hapless hospitals and clinics that they will benefit to having their product because everyone else in this city/county/state/nation uses their EHR so if you want to talk to them, you’d better use the same one as every one else…even if it costs an arm and a leg…even if it doesn’t work well for the doctors and patients.
In other words, the train we needed so desperately has left the station because we wasted time going the rabbit hole instead. And it’s likely not to ever come back in the form we expected from several years ago. So what is a doctor to do if they are forced to use an EHR they don’t like AND they don’t have any leverage to convince the EHR company to improve their product so that it works for them? Stay tuned…