Interoperability - Applying Pressure
More than forty years ago as I completed my Scouting First Aid merit badge, I learned that one of the keys in responding to bleeding is to apply pressure. Of course, applying pressure is not a one-size-fits-all approach. For example, for a simple scrape rather than a cut, applying pressure is not really necessary even though there is surface bleeding. On the other hand, with a puncture wound or a deeper cut, applying pressure is an essential early step to stop the bleeding. And in some rare instances, pressure to the site of injury alone is not enough; stopping blood flow to the area entirely via tourniquet is the only way to stop the bleeding.
Given the requirements and timelines associated with MACRA legislation, pressure continues to be (or is about to be) applied to providers and HIT vendors alike as regulators continue to feel a need to stop the bleeding. But how bad is the bleeding, and are we applying pressure to the right site or in the right way for each patient? The ONC put out a request for information and is seeking input regarding the measurement of progress toward the 2018 MACRA-stated goal of widespread exchange of health information through interoperable certified EHR technology. Measuring progress is one way of applying pressure to stop the bleeding; it is actually a method we at KLAS know well. Transparency is indeed one way to motivate progress.
In a recent meeting that I attended at a local HIMSS function, one CIO stated that the most innovative thing we can do [in healthcare IT] is to say to Washington, 'stop!' His suggestion was that the industry needs time to adopt solutions and optimize. This statement might suggest that the bleeding has stopped or that the flow has at least significantly decreased, and that there is time needed to allow for scabbing and healing to occur.
So are we bleeding in our efforts to reach widespread exchange, or are we at a point where we can simply allow time for healing? The answer, as is often the case, is that it depends. Early insights from providers in KLAS' 2016 study on interoperability suggest that some provider organizations are definitely at the point of healing with very little bleeding, while others are hemorrhaging from a lack of resources, vision, and/or support from their EMR vendors. EMR vendors also run the full gamut, with several providing or moving toward providing great access to both intraoperability and interoperability, while others have not yet identified or implemented the technology or methods for increasing active exchange.
It does not appear that the bleeding has stopped to any large degree. There is certainly a need for continued pressure to move providers toward data exchange where outside data is accessible, easy to find, and in the clinicians' workflow and ultimately benefits patient care. With that being said, there are already significant efforts in the market to apply that pressure, including collaborative groups like CommonWell and The Sequoia Project, efforts from the Argonaut Project and organizations like CHIME to establish and strengthen standards, and ongoing measurement and transparency through studies like our 2016 KLAS study and others. Measurement is not the pressure needed from regulators.
Taking the view of providers, the regulators can intervene by more directly developing, implementing, and enforcing a national patient identifier and consistently applied standards. In a recent conversation I had with a provider heavily involved in standards development, he suggested that the funding of pilot programs to test newly developed standards would be a tremendous benefit. Daily, we at KLAS speak with providers who describe how difficult it is to effectively and efficiently connect to the wide variety of EHRs, and those providers say a major reason for the challenge is the lack of consistent standards. If government leaders want to help provide the necessary pressure to stop the bleeding, they should lead the effort to give providers the tools they need to not only slow the flow but also cauterize the wound.