In the competition between leading EHR vendors Epic Systems and Cerner Corporation, the most recent clashes have centered on the approach each has taken in advancing EHR interoperability, with the latter being credited with having a more open and interoperable EHR technology platform.
That was certainly the reading of industry experts in the wake of the decision by the Department of Defense in choosing the Cerner- rather than the Epic-backed bid for the DoD Healthcare Management System Modernization contract last month. That decision, however, is a microcosm of the widespread work that the Kansas City-based EHR company has undertaken over the past several years.
EHRIntelligence.com recently caught up with Cerner Vice President of Interoperability Bob Robke to discuss the current challenges facing advancing EHR interoperability. According to Robke, the challenges are seemingly but two do stand out from the rest — scalability and incentives. In this one-on-one interview, the Cerner VP shares his thoughts on what stands in the way of a truly interoperable healthcare system.
EHRIntelligence.com: What are the top obstacles in the way of improved EHR interoperability?
Bob Robke: There are probably a hundred different answers to that one. Technology has matured enough where data can flow between most certified EHR technologies. The landscape has drastically improved in terms of technology. There are some use cases that the existing standards around C-CDA may be a little overkill. But for the most part, the technology is there. What we have been arguing about mostly in the industry now is: How do we scale? Two to three years ago, we didn’t see anything emerging that really could scale down to the independent physician, long-term care, or home care.
EHRI.com: What makes scalability and usability challenging in the context of EHR interoperability?
BR: Looking at it from scalability standpoint, cost is a big factor, a big barrier, and trying to connect many things one-to-one or in regions causes a lot of duplicative effort, which causes costs to go up and just doesn’t move the meter very quickly in getting to an expectation of interoperability for both providers and patients. That’s why a lot of what we’re seeing is around scale and how we get to all the nooks and crannies of the healthcare delivery system that can participate in data exchange.
There are a lot of challenges on getting physicians to utilize it. I have examples of connecting four, five, or six different ambulatory EMRs, parsing apart all those C-CDA files, putting it back together in a de-duped and nice way, pre-fetching it so it’s less than two seconds to display — and I still have challenges getting physicians to use it. We definitely have incentive issues.
EHRI.com: What is the right way of pushing EHR interoperability forward? Will it come down to incentives?
BR: Ultimately we should be doing this for the good of the patient. That always doesn’t translate to a business strategy for providers. If we look at those situations where interoperability is used because it is a requirement of business — we’re not paying for duplicate MRIs — that in and of itself would bring in a whole new evolution. As long as it all ends up helping the patient and the provider, then any of those incentives should be on the table.
EHRI.com: How has Cerner approach tackling EHR interoperability?
BR: We have been doing different forms of interoperability for quite a while and mostly around helping our clients connect to their providers that refer in to them, whether it’s sending out results, ringing in orders, or document exchange. We’re up to 125 different EHR vendors we’ve connected in that manner, mostly under the project which our clients are trying to extend out in to their community for business-to-business-type strategies. And then obviously we have been active in CommonWell and are doing things with The Sequoia Project as well. I would consider us looking for any and all places to help our clients connect.
EHRI.com: What does the future hold for Cerner in terms of EHR interoperability?
BR: Obviously, the success of CommonWell is big for us. But our clients have a multitude of different things they want to connect to and different ways they want to connect. We want to maintain our open and interoperable stance in the marketplace and push initiatives that help eliminate some of the barriers associated with interoperability like cost and complexity.
We are also really looking at holistically from the end-user standpoint around how interoperable data gets ingested into their everyday lives without it being a burden or without them having to go through a complex situation of trying to understand a bunch of information from disparate sources — what do trust and don’t trust and service in a way that they don’t have to think about it, it’s just there.
