Obama Administration Report Slams Digital Health Records – Wall Street Journal
The Obama administration took vendors of electronic health records to task for making it costly and cumbersome to share patient information and frustrating a $30 billion push to use digital records to improve quality and cut costs.
The report, by the Office of the National Coordinator for Health Information Technology, listed a litany of complaints it has received about vendors allegedly charging hefty fees to set up connections and share patient records; requiring customers to use proprietary platforms; and making it prohibitively expensive to switch systems.
The report also cited complaints that some hospital systems make it difficult to transfer patient records to rival systems or physicians as a way to control referrals and enhance their market dominance.
The agency didn’t cite any companies by name, however, and said it couldn’t determine the extent of information-blocking—in part because contracts often forbid customers from discussing prices and other terms.
“This is our first deep dive, where we have taken the opportunity to describe the situation and identify practices that interfere with the flow of health information,” said ONC chief Karen DeSalvo. “We believe it will take an array of solutions and we look forward to working with Congress on this.”
Congress requested the report last December amid rising concerns that the government’s massive investment in digitizing health records has created a windfall for the information-technology industry, but left patient records largely stuck in silos.
Spurred by $28 billion in incentives to date, nearly 80% of doctors and 60% of hospitals have converted from paper files to electronic health records, known as EHRs since 2009. But only 20% to 30% of providers are able to share records with outside providers, according to government and industry surveys.
The Electronic Health Record Association, a trade group, said its members are committed to sharing patient records but building connections to the myriad systems used by hospitals, doctors, labs and others takes time and money. “Even if they were all using the same standards, there will always be costs for maintenance and upgrades and making sure the information goes to the right place,” said Sarah Corley, the group’s vice chairwoman and chief medical officer of NextGen Healthcare Information Systems Inc., an EHR vendor and part of Quality Systems Inc.
Some vendors say they aren’t relying on connection fees. As of last week, 25 EHR vendors—representing 70% of the acute-care market and 24% of the ambulatory-care market—had joined the CommonWell Health Alliance, which aims to create a network with low-cost connections so doctors can easily query patient records from anywhere in the system. Vendors build one interface to the network and can connect all their customers to it, and each other, rather than having to create many separate interfaces.
Athenahealth Inc. is offering the CommonWell connection free to the 62,000 physician using its cloud-based EHR systems. McKesson Corp.
plans to do the same for its hospital EHR users. Cerner Corp. says it will offer it to customers free for three years, after a small start-up fee.
To date, only 60 provider sites in 15 states are live on the CommonWell network, but the alliance hopes to be nationwide by the end of the year.
Epic Systems Corp., the privately held industry leader, has declined to participate in CommonWell—in part because it says its 315 large health-system clients can already exchange records with 2,000 hospitals and 25,000 clinics in its proprietary network. “Every system our customers have wanted to connect to so far, we’ve been able to make that happen,” said Epic spokesman Shawn Kiesau.
Connection fees have hit small physician practices especially hard, some observers say.
Farzad Mostashari, a former ONC director and now CEO of Aledade Inc., which helps doctors join together in integrated systems, said he has seen vendors charge small practices as much as $29,000 for an interface to send patient data to other providers, and as much as $1 a virtual page to transmit patient files, which can run thousands of pages.
The ONC report stressed that the agency cannot regulate prices and that most of the alleged actions don’t violate current laws.
ONC does set the criteria that EHR systems must meet for providers to qualify for Medicare incentive payments, or to avoid penalties starting this year. The agency has proposed increased surveillance of EHR systems and more upfront disclosure by vendors of any costs or limitations on data-sharing.
Theoretically, ONC could decertify EHR systems that deliberately block data-sharing, as some lawmakers have suggested, but the report says that would unduly penalize customers.
Micky Tripathi, CEO of the Massachusetts eHealth Collaborative and project manager for Argonaut Project, which aims to accelerate the adoption of open technology standards, predicts that patients will increasingly demand that competing networks work with each other to let their records flow freely. “I’m sure that when the telephone networks and electricity grids were forming, it felt the same way. It just takes a while to shake out,” he said.
Write to Melinda Beck at HealthJournal@wsj.com