The first two stages of Meaningful Use have not gone far enough to develop an industry-wide health data infrastructure, says a new report compiled by governmental advisory agency JASON and funded by the AHRQ. While providers have made great leaps towards implementing EHRs and other health IT projects, the report notes that adoption rates have been laborious, evidence about the benefits of health information exchange has been scarce, and the current level of infrastructure development is not robust enough to support the true interoperability that would produce positive effects on care quality and delivery.
“At present, large-scale interoperability amounts to little more than replacing fax machines with the electronic delivery of page-formatted medical records,” the report says. “Current approaches for structuring EHRs and achieving interoperability have largely failed to open up new opportunities for entrepreneurship and innovation that can lead to products and services that enhance health care provider workflow and strengthen the connection between the patient and the health care system, thus impeding progress toward improved health outcomes.”
While the criteria for Stage 1 and Stage 2 of the EHR Incentive Programs have certainly driven EHR adoption on a larger scale than before, the programs “fall short of achieving meaningful use in any practical sense” due to a lack of unified, open architecture to encourage the free flow of information between organizations.
The report urges greater action by government organizations, recommending that CMS “should embrace Stage 3 Meaningful Use as an opportunity to break free from the status quo and embark upon the creation of a truly interoperable health data infrastructure.” ONC should take the next twelve months to develop comprehensive software architecture for future development that incorporates standards of patient privacy while allowing research organizations to access the appropriate data segments.
In response to the recommendations, National Coordinator for Health IT Karen DeSalvo posted on HealthIT.gov praising the “comprehensive and thoughtful look at the technical challenges in our health information technology system.”
“I am pleased that this report is consistent with our intent to support nationwide interoperability in a way that supports care, health and is flexible enough to meet the challenges of the future,” she wrote. “The ONC and the Centers for Medicare & Medicare Services (CMS) have already begun to work on many of the recommendations cited in the report–although this represents the beginning, not the end of our efforts. The JASON recommendations continue to challenge us to stay focused on the path ahead… [and] builds upon our understanding of the technical, broad policy and privacy and security issues that are both opportunities and challenges as we advance an agenda of meaningful exchange and interoperability.”
“We look forward to discussing the report’s concepts and approach with our strategic partners and to expanding the scope to include a discussion about governance of the exchange and interoperability infrastructure,” DeSalvo added. “The goal is to create a supportive environment for uptake and sustainability. We will move swiftly in the next few months to refresh our Federal Health IT Strategic Plan and then to build a national consensus agenda on health IT. We fully expect meaningful interoperability to be at the top of this agenda based upon what we have learned so far.”
