Although CMS' recently proposed meaningful use stage 3 rules require data exchange between systems and allow for some flexibility for providers to fulfill objectives, a petition filed on Change.org claims it may not be efficient enough.
Donald Voltz, MD, a technology activist and clinical anesthesiologist at Aultman Hospital in Canton, Ohio, began the petition to push the government to enact legislation encouraging innovators to solve the efficiency problems of EHRs. He has been frustrated with the closed systems offered by vendors and how little flexibility they offer to the providers using them, according to the petition.
Although the new requirements for meaningful use include a more rigorous data exchange standard, HIEs are not as efficient as a software that would allow physicians to interact with one another's EHRs, he says. Instead, he advocates for a middleware platform developed by a third party with the input of physicians to solve the problem of exchanging data in a meaningful way.
"HIEs are being designed as data warehouses that store components of EMRs and not allow interfacing into EHRs," Dr. Voltz says. "It shouldn't have to go to three different systems. I would have good patient care and I would have a communication platform that would go back to all these systems. That adds another level on top of the HIE that is not present right now."
The petition says hospital boards have no incentive to adopt technology to solve the communication problems because inaction costs less money than solving the problems. Once a hospital has contracted with an EHR, it is bound to the standards that EHR presents. Instead of requiring all EHR vendors to meet certain standards, if the government allowed third party software developers to build on those systems, it would be a much more efficient way to foster the interoperability required for the ONC and CMS standards, Dr. Voltz says.
Allowing for innovation on existing EHR technology also has potential for improving patient engagement, he says. Current patient portals are designed like a front-end interface to a back-end website, he says, presenting information in spreadsheets and difficult-to-understand formats to patients. However, under new meaningful use standards, physicians are required to enroll their patients in portals where they can view, download and transfer their information. That requirement would be easier to meet if patients actively wanted to engage with the information, Dr. Voltz says.
Physicians are used to regulation, but the somewhat violent resistance to meaningful use has been because they cannot design their own workflows, being forced to work around the existing systems provided by EHRs, he says. Making the APIs available from EHRs could give the physicians and hospitals more autonomy of how they care for patients, he says.
"All those needs are different, and we're all trying to get our patients the best possible care we can," Dr. Voltz says. "My problem with MU is that I don't have the ability to develop solutions to meet the requirements and still meet my needs. Yes, they have some APIs, but they're not as open and available as what would be available on our end. You're giving me a tool, you're giving me a data repository, and you're not allowing me to develop the interfaces into that repository."