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2017 produced a series of important interoperability stories that will spill into 2018, and well beyond.
Interoperability is a controversial and key concept in the evolving American healthcare landscape. The past year produced a series of major stories around the sharing of health records, the key companies and institutions that handle them, and the implications for patients. These are the 4 most important.
The volatile and lucrative healthcare market is seeing consolidation on many levels, with endless interoperability implications. Smaller healthcare practices are being absorbed into large health systems, often bringing together disparate electronic health records (EHR) systems that need to be reconciled. Insurers and health systems are coming together. Those large health systems are also partnering with tech vendors, and pharmaceutical retailers are now buying insurers.
The moves are happening for a multitude of reasons, and interoperability is an important element. How health information travels within the new megasystems, and how they exchange information with each other, both remain to be seen.
3. Natural Disasters
Any destructive, high-casualty event is going to put on a strain on health systems. America faced many of them this year: mass-shootings, wildfires, and a particularly violent hurricane season.
Interoperability is perhaps most essential, and in some respects most inadequate, in emergency departments, especially under the pressure of large-scale disasters. In life-or-death situations, patients aren’t concerned about whether an emergency doctor is in their covered insurance network or if the hospital they are in shares an EHR system with their typical provider. Patient displacement and evacuations can exacerbate the problem.
The major figures in the EHR space entangled themselves and one another in court cases frequently in 2017.
Epic Systems is being sued for hundreds of millions of dollars for allegedly overbilling CMS. Cerner is challenging Epic’s contract with the University of Illinois. More than 60 Indiana hospitals, alongside records company Ciox, are being accused of inaccurately reporting compliance with Medicare Meaningful Use measures and defrauding taxpayers of millions.
CliniComp is suing Cerner for allegedly violating its patents for cloud-based EHR technology. Of course, if CliniComp has a viable case, it may apply to almost every other vendor in the space, too. Many speculate that Cerner is the target for a reason: earlier in the year, CliniComp tried unsuccessfully to challenge Cerner’s involvement in our #1 interoperability story of 2017:
From the first announcement of the deal in June to recent revelations of the VA’s requirements, Cerner’s (still pending) contract with the agency has been the most compelling interoperability story of the year. One VA official called the upcoming project “the largest implementation of a healthcare system EHR ever.”
Representatives from the agency began making specifics and costs clearer late in 2017. In November, Secretary David Shulkin appeared before the House Appropriations Military Construction and Veterans Affairs subcommittee and made his first formal request: Because Department of Defense facilities in the Pacific Northwest were beginning to change over to Cerner systems, he asked the subcommittee for $782 million to be appropriated so the VA could follow suit.
In an Information Technology subcommittee meeting in the House of Representatives in December, VA IT executive Scott Blackburn said that the changeover would take a decade at a cost of about $10 billion.
Representatives were critical.
“If I had walked into a boardroom and asked for $10 billion and 10 years before we could get a system deployed, honestly I would have gotten laughed out of the boardroom,” Rep. Greg Gianforte (R-MT) told him.