EHR vendors are holding patient data 'hostage,' tech expert says

A fellow at the Brookings Institution Center for Technology Innovation writes that the market should drive down interoperability costs.

When the Health Information Technology for Economic and Clinical Health (HITECH) Act created the Meaningful Use Incentive Program, it was a well-meaning move toward obtaining the complete medical histories of patients efficiently and cost-effectively. Years after its adoption, it’s also still one of the few healthcare reforms that has bipartisan support due to the promise of improving patient care and reducing healthcare costs.

But one major oversight in the creation of the requirement to use electronic health records (EHR) systems is that, while it was intended, the law never specified how systems should be interoperable to enable data exchange.

Now, lawmakers-who invested $26 billion in EHR incentives-are trying to fix the problem, but some observers believe market forces would be the best solution.

Niam Yaraghi, Ph.D., a fellow at the Brookings Institution Center for Technology Innovation, writes in a new blog post that EHR vendors have taken patient data “hostage.” That’s because even though it was the intended second step to EHR implementation, vendors are claiming that their systems can’t be interoperable without making costly fixes to technical problems.

“This prevents physicians from sharing their patient records with other doctors,” Yaraghi says. “This is like T-Mobile claiming that its users cannot make calls to AT&T customers. The claimed interoperability limitation does not end here. The vendors are proposing hefty charges to allow data sharing between their own customers.”

Yaraghi says the government has three choices in dealing with this problem: pay EHR vendors to release patient data at a hefty cost, force vendors to improve interoperability through new regulations, or allow the market to dictate a solution.

The first option is already happening and laws are already being drawn up to facilitate the second option, but Yaraghi says the EHR industry will resist any such efforts. “The benefits of regulating the EHR industry, if any, will take a very long time to become tangible. The EHR vendors will furiously push back against any kind of regulation and will insist that technical challenges are a real barrier to interoperability,” he says. “Congress is poorly situated to adjudicate this claim. Time is a critical factor in the long term success of HITECH plans, which threatens the viability of this strategy.”

Yaraghi believes the third option offers the best fix. “Because the market for new EHR products is now saturated, the only revenue source for EHR vendors are charges for data exchange. Currently, they can get away with outlandish charges because they know the incentives from the federal government allow doctors to cover their costs,” he explains. “But if the free money from the government were to stop, then EHR vendors would have to persuade the physicians to pay for the exchange fees. Just like any other service, the highest price that the medical providers would pay is equal to the value of the service for them.”

Medical providers would be willing to pay a fair price for a service that will help them lower their costs in the long run, thus allowing the market to set a price based on value and demand. EHR vendors who don’t offer reasonable fees will eventually go out of business, Yaraghi says.