HHS’ $30B Interoperability Mistake

Sometimes things are so ill-advised, in hindsight, that you wonder what people were thinking. That includes HHS’ willingness to give out $30 billion to date in Meaningful Use incentives without demanding that vendors offer some kind of interoperability. A staggering amount of money has been paid out under HITECH to incentivize providers to make EMR progress, but we still have countless situations where one EMR can’t talk to another one right across town.

When you ponder the wasted opportunity, it’s truly painful. While the Meaningful Use program may have been a good idea, it failed to bring the interoperability hammer down on vendors, and now that ship has sailed. While HHS might have been able to force the issue back in the day, demanding that vendors step up or be ineligible for certification, I doubt vendors could backward-engineer the necessary communications formats into their current systems, even if there was a straightforward standard to implement — at least not at a price anyone’s willing to pay.

Now, don’t get me wrong, I realize that “interoperability” is an elastic concept, and that the feds couldn’t just demand that vendors bolt on some kind of module and be done with it. Without a doubt, making EMRs universally interoperable is a grand challenge, perhaps on the order of getting the first plane to fly.

But you can bet your last dollars that vendors, especially giants like Cerner and Epic, would have found their Wilbur and Orville Wright if that was what it took to fill their buckets with incentive money. It’s amazing how technical problems get solved when powerful executives decide that it will get done.

But now, as things stand, all the government can do is throw its hands up in the air and complain. At a Senate hearing held in March, speakers emphasized the crying need for interoperability between providers, but none of the experts seemed to have any methods in their hip pocket for fixing the problem. And being legislators, not IT execs, the Senators probably didn’t grasp half of the technical stuff.

As the speakers noted, what it comes down to is that vendors have every reason to create silos and keep customers locked into their product.  So unless Congress passes legislation making it illegal to create a walled garden — something that would be nearly impossible unless we had a consensus definition of interoperability — EMR vendors will continue to merrily make hay on closed systems.  It’s not a pretty picture.

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.


  • some others have commented that interoperability cannot happen unless there are some “tangible benefits” for institutions and vendors.
    I say this. the entire ‘raison de etre’ for an EHR is accessibility. there is really no other benefit. it doesn’t save time . it doesn’t save effort. Despite what others opine, in my experience there is no safety benefit (meds) and there is probably a hazard. So if an EHR doesn’t make a patient’s record accessible to other physicians when the patient desires that, what is its purpose?
    a cynical person might note that the giant vendors (epic, cerner) pull alot of money out of the public trough, and redistribute a fraction of it back to the legislators themselves through our terrific system of political contributions. is that the current ‘raison de etre’?
    i also note that a small fraction of physicians, who identify themselves as university professors, love the EMR for its potential to allow ‘big data’ mining. Unfortunately these same physicians, whose residents and fellows perform the majority of data entry for them, speak loudly when called upon by our legislature to opine on the benefit of the EMR.
    Who is speaking for the patients and the vast majority of physicians, for whom the EMR currently acts as an impediment to the delivery of effective healthcare?

  • When it comes to legislation and rulemaking, users don’t have a seat at the table. There is no national EHR user group representing the grunts, as it were, who have to put up with poor usability and interoperability.

  • Rather strange don’t you think that back in 2012, one CA-based MCO with 100 member clinics (many different EMRs across the membership) was able to solve the interoperability puzzle?

    As the designer of the software commissioned by Coast, we never found out what happened following the pilot run – Coast got bought out and we have no clue what happened after this.


    Civerex even offered at one stage to donate it’s Data Exchanger to HHS – we never heard back from HHS either. I wish I had kept a copy of our e-meil offer.

    As the article suggests, it seems there are forces at work that do not want interoperability to happen.

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