Copyright Forbes
When I was growing up, the telephone company meant the Bell System. It provided the phones and local and long-distance service. But in just a few years during the 1980s, that market domination ended as anti-trust efforts broke “Ma Bell” into eight regional “Baby Bells.” At the time, this fragmentation set off alarm bells. The New York Times warned of the risks of allowing the future of a vital telephone network to be determined by “the forces of competition, rather than a government-backed monopoly.” Despite setbacks and challenges, it’s clear that fragmentation made phone service less expensive and more accessible. I’ve been reminded of this history as another, even more vital aspect of American life is undergoing fragmentation: healthcare. As massive tech companies such as Apple and Google, and other non-traditional providers like retail giants Amazon and Walmart enter the field, I hear echoes of those concerns in the current debate about quality, costs, and people burdened with too many choices. But I’m confident that the revolution in the delivery of care will ultimately be a boon to patients as traditional care is supplemented and enhanced by new options that increase the capacity of the entire system. My confidence comes with a major caveat. The great challenge going forward in this fragmented future is ensuring continuity of care when a patient might schedule a telehealth appointment with Amazon’s One Medical app, receive immunizations in their grocery store, visit an urgent care center for treatment, have prescriptions delivered by Cost Plus Drugs, and go to their local hospital’s ER for a medical emergency. Mind the Gap To begin to address this challenge, we should focus on the great constant in patient care: electronic medical records (EMR). EMRs are the history every provider should consult before prescribing care, and so they must all work together. Interoperability that safeguards privacy should be our mantra to ensure that different health systems can share relevant patient data, securely store it, and make it accessible to the healthcare providers who need to view it. Although that should be the case, it isn’t, despite considerable effort from the U.S. Department of Health and Human Services (HHS). In 2016, HHS mandated the creation of the Trusted Exchange Framework and Common Agreement (TEFCA) to remove barriers for sharing health records electronically among healthcare providers, patients, public health agencies, and payers by imposing a minimum set of interoperability standards. This mandate, however, has failed miserably. Why? My strong belief is that EMR providers not only make it difficult for their systems to interact with those made by others, but they also make it hard for one health system using their EMR to have full interoperability with another healthcare system also using their platform! EMR companies usually claim that various factors make record sharing a challenge. However, there is a more nefarious possibility; creating barriers to interoperability is a business strategy that ties users to their systems. John Henderson, vice president and chief information and digital officer of San Diego-based Rady Children’s Health, suggested the complexity of this problem when he told Becker’s Hospital Review that interoperability is a “deeply rooted issue involving legacy infrastructure, fragmented standards, privacy concerns, misaligned incentives and placing the burden of interoperability on each healthcare facility while the technology vendors continue to make minimal advancements that are meaningful for the patient and provider health system.” Imagine the chaos if AT&T, Verizon, and Sprint customers could only call users within their own systems. That is where we are with EMRs. As we move inexorably into a world of more fragmented care, the stakes will get even higher if providers can’t share patient information safely and securely. Until there is a mandate with teeth, I don’t see interoperability succeeding. Despite all efforts, control of patient medical records represents a competitive advantage for EMR companies, one of many contributors to high healthcare costs. Ultimately, we should require what was required of telephone companies as they entered a competitive phase of their existence. We expect interoperability, calling or texting without considering whether the people we’re communicating with share our provider. Shouldn’t we demand the same in healthcare?
