Originally published March 20 by the MIT Initiative on the Digital Economy.
On March 17, the Trump administration announced the expansion of telehealth for Medicare patients. The goal is to cope with the coronavirus by easing existing restrictions on telehealth usage. Telehealth allows physicians and other providers to communicate with patients directly via online video applications, such as Skype, FaceTime, and Zoom, rather than meeting patients face-to-face. Telehealth will reduce the risk of spreading the coronavirus and the disease it causes, COVID-19. In addition, restrictions have been loosened on transferring patient diagnosis and treatment data across providers to facilitate telehealth treatment.
However, transferring that information is very difficult because the electronic health records systems that contain patient diagnosis and treatment data for one health provider often cannot communicate with other providers’ EHRs. This limitation could endanger millions of senior patients with comorbidities, such as diabetes, heart disease, and emphysema, who are particularly at risk of coronavirus because telehealth providers can’t get direct access to their medical data.
Electronic health record compatibility issues
Moreover, if electronic health records had the well-defined interfaces necessary for intercompatibility — such as Fast Healthcare Interoperability Resources application programming interfaces — it would be easier to connect and create an ecosystem of third-party service providers. With better compatibility, telehealth and other healthcare organizations would not need to provide services for which they do not have the resources. Instead, they could use EHR intercompatibility to leverage the platform ecosystem, such as Cerner (an EHR technology firm) recently connected Uber’s non-emergency medical transportation service.
If systems were compatible in this way, this capability could be easily shared with other electronic health records systems during a crisis. Third-party platform services could quickly add capacity to overstretched sectors, such as patient appointment scheduling. They could also add capabilities such as automatically texting test results to patients.
While it may be too late to remedy the lack of intercompatibility and platform services for the current crisis, significant change appears to be coming. On March 9, the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology issued rules for EHR interoperability — and hence platform services — that were authorized under the 21st Century Cures Act.
It’s important and interesting to consider the reactions of the various players in the health care IT industry. Why have some electronic health record giants been fighting the implementation of the 21st Century Cures Act with such surprising vigor? The crux of their argument is the valid concern that poorly conceived applications could leak data a la Cambridge Analytica. However, the concern is also self-serving because these EHR providers’ ecosystems of platform applications are weaker than their competitors’ and blocking implementation impedes their competition. Other EHR players — as well as Microsoft and Apple — have given the rules strong support, as have health insurers and providers.
The coronavirus pandemic underscores the potentially deadly implications of the lack of intercompatibility of electronic health records and the need for the tremendous innovation and agility of open platforms. In the long term, such innovation will also help the nation cope with the issues of cost. However, for this vision of innovation and data exchange to be realized, governing bodies (including the federal government itself) must require that all electronic health records, no matter their brand, work with one another, and, specifically, that tools like Fast Healthcare Interoperability Resources APIs be deployed across the industry.
At that point, not only will data exchange finally benefit all patients in all hospitals and practices, but the platform revolution will finally come to the U.S. health care IT industry.
Geoffrey Parker is a professor at the Thayer School of Engineering at Dartmouth College and a research fellow at MIT’s Initiative on the Digital Economy.
Edward Anderson is a professor at the University of Texas McCombs School of Business where he researches the effects of information technology on health care operations.
Nora Belcher is the Executive Director of the Texas e-Health Alliance, a nonprofit advocacy organization based in Austin, Texas.