A group of leading electronic health record (EHR) vendors and hospitals have united to address interoperability, the maddeningly rare ability to transfer records between different EHRs with ease.
The EHR market consists of hundreds of companies, each with a line of products. If a patient has doctors in multiple facilities using different EHRs, they often face serious challenges in getting record from one to another.
“We’ve spent half a million dollars on an electronic health record system about three years ago, and I’m faxing all day long,” a frustrated physician told The New York Times. “I can’t send anything electronically over it.” This sentiment is widely echoed throughout the industry; vast sums spent on new technology have yet to yield basic, essential capabilities.
The Argonaut Project, announced December 4th, is the private sector’s response to the problem. The initiative is led by Health Level Seven International (HL7), a non-profit dedicated to this issue, in partnership with five of the largest EHR vendors — Epic, athenahealth, Cerner, McKesson, and MEDITECH — along with prominent hospital groups including the Mayo Clinic and Partners HealthCare. The team hopes to make its Fast Healthcare Interoperability Resources (FHIR) available this spring.
The five EHR developers have a combined market share of 45% of hospitals and 28% of ambulatory care, according to Modern Healthcare. Additionally, HL7 claims that its 2000 members include over 90% of EHR vendors, meaning a successful interoperability program would likely be near universal, as the remaining vendors would be pressured to comply to avoid losing their customers.
The federal program driving EHR adoption, known as Meaningful Use, requires that EHRs be interoperable to qualify for incentives. In practice, it is usually challenging, costly, or simply impossible to transfer files between different systems electronically.
Many have blamed the EHR vendors for the difficulties, particularly Epic, which was singled out in Congressional hearings earlier this year. Over 50% of Americans have a health record with Epic, the single largest vendor in the country. For Epic, poor interoperability (or the perception thereof) could conceivably help bring even more customers who fear the inability to interact with the many existing Epic databases.
Epic shifts the blame onto the federal government for not creating a unifying protocol, as the Argonaut Project is now attempting to do. “I’m not sure why the government doesn’t want to do some of the things that would be required for everybody to march together,” Epic’s founder Judith Faulkner told the Times.
To mitigate what she saw as government shortcomings, Faulkner started Epic’s Care Everywhere program in 2005, an early framework for data transfer between Epic clients which was since been adapted to connect other EHRs.
The issues addressed by the Argonaut Project and Care Everywhere are not limited to the logistics of transferring the data securely, but also include agreements on how one institution will handle data that has been entrusted to another. Sharing that data requires great trust, as providers can be held responsible for breaking HIPAA regulations if they release data to irresponsible partners.
The Argonaut Project may resolve these concerns decisively, making a great stride toward a model of modern health informatics in which technology finally lives up to its promise.