What are the remaining barriers to achieving EHR interoperability?

Over a decade ago, when the U.S government’s push for EHR adoption began in earnest, the driving force behind this initiative involved achieving the “triple aim” of better care, improved population health and lower costs. Policymakers view EHR as the foundation on which providers in the U.S healthcare system could seamlessly share and analyze patient data across care settings and organizations with the end goal of improving overall population health. Despite spending substantial resources towards this goal of a holistic and integrated health system, actually realizing this objective remains well out on the horizon.

the day to day functioning and usability of an EHR system represent the consumer's top priority"

Health IT sector observers note that the primary reason as to why EHRs have not yet fulfilled their promise rests in the difficulty providers face when sharing information among organizations using different EHR systems. This so-called interoperability problem, is not a novel problem to EHR, in fact other forms of technology have historically struggled with this issue (notable examples being VHS and Beta movie systems or Apple and MS-DOS operating systems). EHR suffers from the same limitations as a diverse software landscape breeds compatibility issues. This leads to the question:

After over a decade of EHR implementation, what are the remaining barriers to achieving EHR interoperability?

One of the most significant obstacles to EHR interoperability rests in consumer sentiment. Despite the government’s meaningful use initiatives crafted to “carrot and stick” providers to adopt more sophisticated EHR a robust demand for interoperable EHR technology remains to be seen.

Investment in a single EHR system often occupies a large segment of a provider’s technology budget. Given this fact, providers often elect to live and die by their choice of EHR only electing to abandon for a new system in extreme circumstances. This mentality can sow the seeds of over commitment to their existing EHR system as a way to make the most of sunk costs. If the current system performs well internally but lacks interoperability with other systems, a provider will likely remain with the system. You will not see health care providers queuing up like iPhone users for the latest and greatest version. Rather the EHR system-user relationship is a bit more complicated only falling apart in the event of a major catastrophe.

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Of these reasons for going to the next bigger or better thing in EHR, providers often cite significant flaws in basic functionality or customer service as the impetus for defecting to a new system. However, if the system performs well in these functions, a provider will likely remain committed to their existing EHR system. Unfortunately for interoperability advocates, if a system is performing well at its core functions, yet is not interoperable with other EHR systems a provider will likely not defect to a new system for this reason alone. Survey data confirms this point, indicating that users rarely (if ever) ditch their current system on account of its poor interoperability.

As such, EHR consumers are sending signals to EHR vendors that although interoperability may be a long-term priority for government, the day to day functioning and usability of an EHR system represent the consumer's top priority, thus relegating interoperability to the status of a luxury add-on. Evidence of this sentiment is found in a KLAS survey asking which interoperability platform or feature has most improved care delivery within their organization from a list of seven technologies or approaches, nearly a third (32%) of respondents answered “none.” Another 16% picked an integrated EHR; leading researchers conclude that almost half of providers hoped to avoid the issue of interoperability because of its “complexity and pain.” Sadly for the case of EHR interoperability, being associated with “complexity and pain” does not bode well for the immediate future.