The EHR Interoperability Disincentive
“If you bring her to our urgent care, we’ll be able to see what was done in her record,” the pediatric R.N. told me with a winning smile when I’d asked what to do if my 3-year-old’s urinary tract infection wasn’t better by the following day, a weekend. It was a subtle and winning bit of patient steerage that I’d run into many times before, both personally and when dealing with health issues for my children. There is an urgent care office just blocks from our home, but when ill, my doctor and my children’s doctor always advise me to go elsewhere. Why? My doctor and my children’s doctor are from two different health systems that each compete for urgent care business with the urgent care center in our neighborhood, which is itself is part of a third large health system. All have advanced EHR systems and none of them can share records with each other. Nor do I think they really want to. If health records really could seamlessly move between different health systems, the “leakage” of patients to outside facilities that provide everything from urgent care to imaging would only intensify. Radiologists are the pioneers in interoperability because of the cost and safety issues involved in repeating scans needlessly. But interoperability is a bit at odds with the big health care network model, which is most profitable when patients stay in the network. Currently, CMS is seeking feedback on how to create economic incentives to advance interoperability in EHR systems. Perhaps independent outpatient groups in radiology and other specialties might bring to the government’s attention the economic incentive large health care networks have in keeping information in silos.