Moving Past the EHR Interoperability Blame Game

Julia Adler-Milstein, PhD | NEJM Catalyst | February 22, 2017

As a researcher who studies electronic health records (EHRs), I’ve lost count of the times I’ve been asked “Why can’t the systems talk to each other?” or, in more technical terms, “Why don’t we have interoperability?” The substantial increase in electronic health record adoption across the nation has not led to health data that can easily follow a patient across care settings. Still today, essential pieces of information are often missing or cumbersome to access. Patients are frustrated, and clinicians can’t make informed decisions. When our banks talk to each other seamlessly and online ads show us things we’ve already been shopping for, it is hard to understand why hospitals and doctors’ offices still depend on their fax machines.

A big part of the reason is that interoperability of health information is hard. If it were easy, we would have it, or at least have more of it, by now. Though it’s a technological issue, it’s not just a technological issue. As we have seen in other industries, interoperability requires all parties to adopt certain governance and trust principles, and to create business agreements and highly detailed guides for implementing standards. The unique confidentiality issues surrounding health data also require the involvement of lawmakers and regulators. Tackling these issues requires multi-stakeholder coordinated action, and that action will only occur if strong incentives promote it.

Though billions in monetary incentives fueled EHR adoption itself, they only weakly targeted interoperability. I have come to believe that we would be substantially farther along if several key stakeholders had publicly acknowledged this reality and had made a few critical decisions differently. While it’s too late for “do-overs,” understanding initial missteps can guide us to a better path. Here is how those key stakeholders, intentionally or not, have slowed interoperability...