Interoperability: A Love Battle

Posted by Ron Decker on 03/02/2020

It is in some ways flattering that in the great anonymous corners of the world there are known faction warring for our allegiance as consumers. We feel important, valued, both good feelings. This is perhaps one of the only upsides to a role otherwise troubled by a deluge of solicitations, misleading campaigns, trash beauty products, bad food, toothpaste, fad diets, false appeals to the heart.

Being vied for becomes a bit more muddled, however, in healthcare debates, an industry in which the consumer is even less surefooted due to the processes required in really getting a firm handle on that foreign organism that is the human body (I feel confident, for instance, making decisions about the right brand of cereal, yet I’d feel less good about applying that independence to heart medicine) and all the red tape that interferes with accessibility, not to mention the dire consequences of getting it wrong. But if you pay attention, bigwigs in the healthcare industry make appeals to us as consumers quite strongly too.

In February 2020, HHS announced that it’s adopting interoperability rules put out last year by the CMS and ONC aimed at addressing access, exchange and use of electronic information, and preventing healthcare organizations from using information blocking tactics. HHS director Alex Azar said the rules are “essential to building a healthcare system that pays for value rather than procedures, especially through empowering patients as consumers.” HHS, it appeared, made the decision with us at the fore of its mind.

Over the past few years much of the industry has begun shifting away from redundant fee-for-service models toward value-based ones. This has helped lower costs by pushing treatment courses on the merit of their effectiveness, not profitability. So when HHS announced it would be implementing measures for easier data sharing that push this evolution forward it was mostly seen as positive.

Yet shortly after the publication matters were complicated when healthcare software giant Epic, out of Madison, WI specializing in EMR and EHR software storage, sent a letter signed by an unavoidably lengthy list of hospitals citing concerns over patient privacy. Founded in 1970, Epic is one of the largest storage houses of EHRs so you would not be alone in seeing their defense as mere protection of a de facto stronghold using the guise of patient privacy to conceal this special interest. A more sympathetic view might see them as experts attuned to the complexities of software storage who worry that opening data sharing up for purchase and exploration by third-party IT groups might put at risk sensitive medical information.

The notable thing, though, is how both HHS and Epic cling to the noble position of being defenders of patient and consumer interest. But mark how differently, how interchangeably, the two employ the term consumer and patient, how malleable the term is, with HHS using the language of choice, empower, and Epic, defense and protection, and both reaching antithetical opinions over what is best for us. To be a consumer in this context is to be a very important abstraction, the most important empty chair in the room.

Regardless of who is closer to the truth both parties should take seriously their claims of devotion to the consumer by investing and not hamstringing innovations that might help solve some of the irrefutable headaches that plague this industry. As patients and doctors, as consumers endowed with the power of indifference and ire, it is high time for us to stop being seen as cynical pawns in this tumultuous debate over what is best for the consumer of healthcare while being largely excluded from the conversation. We should be courted as the formidable consumer base we are and looked at as discriminating entities more than willing to turn away from inferior practices, irrespective of which of our supposed protectors is claiming to hold us dearest.

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