Additionally, let’s not minimize the technical and structural challenges in developing health IT interoperability. These potential obstacles are significant, especially considering the hundreds of different EHRs. Some of these challenges include insufficient interoperability standards, variation in state privacy rules and laws, problems with accurately matching patient medical records, significant costs, lack of trust between vendors, and data security concerns.

Hmm, maybe this sausage doesn’t smell so good…

The three main components of the health IT interoperability pledge are to help patients access their personal health information, to help providers deliver better care through information exchange, and to prompt the government to improve interoperability standards and policies. While consumer demand and government weight can potentially produce some movement, what leverage do individual providers have?

To be sure, there are some health IT developers that are working to improve access to medical records for providers despite the challenges. In Maryland, there is the nonprofit Chesapeake Regional Information System for our Patients (CRISP), which has implemented a statewide health information exchange. As a provider, I can access a patient’s medical records from my computer in the emergency department and look at medical record documents such as discharge summaries, laboratory and imaging results, and prescription information from other providers. Upcoming enhancements will include actual image exchange. In Washington and Oregon, there is the Emergency Department Information Exchange (EDIE) by Collective Medical Technologies, which is a private, for-profit corporation. Again, this system allows for real-time access in the emergency department to medical records from many participating health care institutions.

Why would they give away potential profit? Aside from governmental pressure and consumer demand, what is their incentive? How will it benefit their shareholders?

Both of these models are add-on systems to regular EHRs from the major health IT developers. Both have required substantial infrastructure development and investment from private and public partners. They are works in progress but have substantially positively affected the ability of emergency providers to deliver care in the states where they have been deployed. But, as stated, they are not the core health system EHRs.

It would be great to see this pledge fulfill its promise. Obtaining the most recent CT angiogram from an outside hospital on a patient presenting with chest pain can save time and money and reduce patient exposure to ionizing radiation. True health IT interoperability is critically needed to improve our ability to efficiently and effectively deliver modern care.