What If EMR Interoperability Was Mandatory?

For decades, industries have haggled and coded and bargained their way into shared data standards.  Each agreement has made great technical advances possible and grown markets into forms which could hardly have been imagined before.

Traditionally, the idea has been agreeing on interoperable standards is a form of enlightened self-interest.  The equasion “interoperability=larger markets=more pie for everyone” has nearly always managed to take root even in industries as brutally competitive as networking.  Consider where we’d be without 802.11 for WiFi, for example. If WiFi manufacturers had staged a prolonged battle over standards, and the reach of WiFi didn’t blossom everywhere, the Internet as we know it might not exist.

Well, here in EMR vendor land, we’ve somehow passed the exit marked “coopetition” and wandered off into interoperability nowhere land.  Sure, tell me about the CommonWell Alliance, which looks, on the surface, something like industry cooperation, and I’ll retort, “too little, too late.”  And do I even have to say that the idea that Epic supports everybody is something of a laughing matter?

Maybe, after seeing how miserably the EMR vendor industry has failed to come together to share data, it’s time to force the matter.  I read that ONC  honcho Farzad Mostashari has occasionally threatened to do just that, but hasn’t followed through with any proposed regs on the subject.

What if the FCC, the FDA and the ONC (which are now taking comments on a regulatory framework for health IT) decide to look at standards, pick a winner and shove it down the ever-living throat of every uncooperative vendor hoping to create dependency on their way of doing things?  That would include Epic, of course, which today, hears countless hospital CIOs say they had to buy their product because everybody else did.

Don’t get me wrong, this is a very, very serious matter; any regs that attempted to force interoperability would impose untold billions in costs on vendors, not to mention their customers. But if interoperability is the real prize we’re ultimately hoping to gain — the big EMR enchilada — is it possible that it’s time to take the risk anyway?  I don’t know, but I certainly wonder.  How about you, readers?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • In 2012 Governor Deval Patrick signed into law the Massachusetts Healthcare Cost Containment Act, better known as Chapter 224 of the Acts of 2012. A provision of this first of its kind legislation mandaters that by December 31, 2016 all ACO’s, PCMH’s and risk bearing providers in Massachusetts MUST have interoperable EHR systems. Many other states are looking once again at the ground being tested by Massachusetts as they develop their own future healthcare legislation. The true question here is not “what if” but rather “when will it be”

  • Imagine what it’d be like if cellular phones could not talk to land-line phones!

    Thanks to governing bodies such as CCITT now known as the ITUT for Telecommunication Standardization.

    Which body in the U.S. do you suppose has the latitude, fortitude, independence and promises to provide such required level(s) of governance for the EMR/EHR industry? Certainly not the ONC.

  • Made the same points 10 years ago; we needed HIPAA like regulations for EHRs — right at the start and before they get too far along!

  • I find it very interesting that people state there is no interoperability among healthcare systems. Has no one ever heard of HL7? I have been implementing HL7 interfaces between healthcare systems for at least 20+ years as it is a well defined and wide spread integration standard and has from the beginning allowed discrete data elements to be shared amongst systems in addition to the use of coded standards such as LOINC and SNOMED. Vendors have, admittedly grudgingly, supported the HL7 standard because the customers (hospitals and health systems) have demanded they do so or else they would not spend the millions of dollars it cost to purchase and install the vendor systems. The smarter vendors realized early on that supporting the HL7 standard actually gave them a competitive advantage in the marketplace. (EPIC does support HL7 by the way.) Just because the HL7 standard was created by a group from within the industry and not a government agency is not a reason to dismiss it. As a matter of fact the government has started to promote portions of HL7 as the accepted official standard. So why all this talk of no interoperability? I don’t get it.

  • Since my company has been in the EMR arena since 1999, and since I have personally dealt with the disparities stemming from lack of interoperability as a cancer patient, I would say it is indeed time for standards to be mandated and a winner to be crowned.

    In one day, I might go from a PET/CT scan at Washington Hospital Center, to radiation or chemo literally next door at the Cancer Institute, to physical therapy just across the street at the National Rehabilitation Hospital. All three had separate medical records for me. In every case, every time I wanted to share a test result or diagnosis with more than one doctor, I had to send an email to one granting permission to send a record via email to the other…and all facilities fly under the MedStar banner…absurd!

    We all know that the stall in convergence has little to do with any lack of technical solutions. The problem is that the dark and nasty underbelly of free market competition has motivated companies to block progress while they jockey for dominance.

    Anne Zieger is correct. The government must unite and become the tail that wags the dog. First end the turf war between VA and DoD, instead of having annual bake-offs between between AHLTA and Open VistA. Second, have a panel of HIPAA, ONC, CMS and other govt representatives work a one-year deadline to assess and declare a winner. Third, promulgate the winner throughout DoD, VA, CMS, etc. Industry can get on board or get out of the field. As the author points out, we have indeed missed the turn to coopetition, and the greed that sent us down the road we are on is literally killing folks.

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