Whether you are a medical provider or a patient, this article will have the same impact on you and leave you in shock over the state of the industry.
Everyone in healthcare is being pushed to move patient care above profits, except the software companies that have complete control over how we collect, use and analyze the information vital to that very care. Interoperability is talked about daily, in technology and healthcare publications, but what isn’t discussed is the real reason this technology hasn’t advanced as fast or far as all other applications across other industries:
“Interoperability describes the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user, (HIMSS n.d.).”1
Think about this…Every day you exchange Word© documents, Excel© documents, Adobe© PDF files: the list of documents you can exchange between multiple programs is endless. Why? Because visionaries at these software companies realized a long time ago that the real value of their product was how many industries they could touch and how fast, because data exchange in a universal format is the key to longevity and efficiency. Electronic health record software designers thought they were above this notion and for the past twenty years, have built applications that keep data in silos from which it can barely be extracted without their assistance and often additional charges.
“Even as the healthcare information technology (IT) field has made strides to facilitate cooperation between EHRs (electronic health records), it’s become abundantly clear that we still have a way to go to achieve anything approaching complete and total interoperability. All attempts at interoperability must inherently begin by recognizing the starting point that makes everything so tricky: EHRs consist of a series of disparate systems built in silos that are suddenly being asked to work together for the good of the patient,” (Castillo 2018).2
Luis Castillo is President and CEO for Ensocare, a SaaS care coordination company. In his Forbes article, “The State Of Interoperability In Healthcare,” he discussed that this isn’t necessarily the fault of providers:
“Restricted somewhat due to Health Insurance Portability and Accountability Act (HIPAA) regulations, competition and the very nature of the current system, healthcare as a whole finds itself in quite a predicament. While tech developers in other industries continue to come up with apps, software and hardware that create entirely new sectors of business, healthcare struggles to garner the widespread adoption necessary to simply ensure that providers are able to successfully communicate with one another,” (Castillo 2018).
We could not agree more, and our focus is not on providers because they are the very group that software companies are holding hostage in order to generate revenue and prohibiting true interoperability (patients are also held hostage by this group, but they are merely collateral damage because they do not generate any licensing fees or other related revenue.) The deeper we dug into the issue the more shocking the truth of the issue became: This has nothing to do with providers, and everything to do with greed and the software companies.
Allow us to give an example of this problem: We had a new healthcare provider as a client that had 5 offices in the Midwest, and had been providing care to patients for 20 years. When they decided to hire us for billing and a new EMR, they requested their data on 56,000 patients one of these top-10 EMR companies was holding. The cost request for that data was answered with a one page contract for data export services and a bill for nearly $10,000.00. MTBC did not think that was a fair charge (because MTBC does not charge anything for providers to get their data), and as such, we paid for this clients data with a 2 month deadline for delivery. When we flew out to this clients’ office to import the data and setup their system on our EMR, we were surprised to find this third party vendor had taken our money, but also deprived our client of the data with no true explanation. This vendor took their fee and told us that there was an error in exporting the data because of missing fields in patient demographics, and when we asked for a refund, they said there was too much work that had gone into researching the problem and they could not justify refunding the payment! So, there was no data as promised, and no refund. MTBC then enlisted the help of two consultants who specialized in that EMR, and summoned their on-staff development team to extract what was needed. Within 30 days they had extracted all 56,000 patients, placed it into the MTBC EMR and tested it to ensure the practice had everything needed in order to operate.
How is this possible you may ask; weren’t there supposed to be Health Information Exchanges setup to deal with this very problem? Why yes, there were, but those failed too. According to the Official Website of the National Coordinator for Health Information Technology; a “Health Information Exchange allows health care professionals and patients to appropriately access and securely share a patient’s medical information electronically,” (healthit.gov n.d.)3 That is accurate in theory, but in application it is not as easy to convince everyone to utilize a vehicle by which the data can be exchanged:
“For more than 20 years, hospitals and physician groups in markets around the country have made repeated, and often disappointing, attempts to share patient information they have stored electronically. In 2009, the federal government started sending $548 million to the states to set up public HIEs. Several (Connecticut, District of Columbia, Tennessee, Nevada) have failed, and many of the rest are struggling financially. A 2015 study supported by the Robert Wood Johnson Foundation reported that the list of 202 public and private HIEs it had been tracking fell to 158 when defunct and misidentified exchanges were taken off the list,” (Greene 2016).4
How again, could this failure have happened with HIE’s attempting to solve this problem? According to Jan Greene in Managed Care Magazine’s article in 2016, it was technical complexity, competitive pressure, and lack of a business model. We would like to point out that two of those factors (if not all three) have one commonality; they are rooted in the software vendors applications and or lack of interest in cooperating with HIEs. Further, those EMRs that could be used to exchange data were either silent on their intention to join, interface, or participate in the exchanges, or made it widely known that they were going to start their own proprietary exchange systems or formats.
MTBC, determined to solve the interoperability problem for its clients, began to invest in an idea starting in 2016 that would address this issue. We knew that there was a problem that was not based in technology: this was a problem about what companies were willing or not willing to do with their capabilities.
MTBC began looking at how to solve this issue from within the confines of an EMR. The MTBC EMR, TalkEHR© was already a free software solution being used by several thousand providers. We had created the first voice integrated EMR to allow providers the ease of hands free documentation, but without the costs associated with this technology in an already over-priced market. MTBC then began to look for ways to create a universal EMR exchange. Thanks to CMS incentives that were given, most EMR’s needed to be able to export a file format called CCDA to gain MU3 certification. That in turn, caused software companies that wanted to be picked by providers to get EMR financial incentives, to get their software certified and provide this file format export capability. The problem remained, that absent legislation on the topic, there was nothing that prevented software companies from leveraging heavy charges for this data extraction, rather than giving providers the capability of moving their data between EMR systems.
MTBC began to look for a way which could facilitate the exchange of data, securely, and for minimal costs. The answer was rooted in blockchain technology: Originally implemented as a core component of the cryptocurrency bitcoin, where it served as the public ledger for logging all transactions on the network, blockchain is a distributed database that maintains a continuously growing, chronological list of time-stamped records, called “blocks.” Each block is connected to the one before it, creating a virtual chain of data. The technology is distinct in that it offers a safe, secure, verifiable means of storing and tracking records.
“To understand blockchain’s impact on interoperability, it’s important to understand how blockchain works in simple terms. A blockchain database is a distributed database that records and stores transaction data in the form of time stamped “blocks” linked to each other in such a way that no one can alter any transaction data… Any action on a blockchain is a function of the network, so to alter any transaction data, a person would need to modify the same data in all the nodes in the network – making hacking practically impossible as someone would need to hack into all the systems in the network at the same time. In addition, blockchain is consensus-based, so every transaction needs approval from more than half of the participants or nodes before execution. While every transaction in blockchain is public, access to the content of each transaction can be restricted based on the sensitivity of the transaction,” (Shah 2018)5
Making that connection between healthcare need and IT capability in June 2018, MTBC announced the release of new blockchain technology network integrated with the company’s EHR platform to securely store patient medical history, eliminate interoperability issues, and give patients’ absolute control over who has access to their valuable health data. This model allows for patients to have complete restriction control from an application, to allow their records to transfer between provider’s EMR systems for specific or definite durations. This also allows providers to have their patient electronic record synchronize over the network, securely, so there is no need for duplications or multiple systems.
What does this solution to interoperability cost the patient, provider or software vendor? Right now…$0.00. MTBC is allowing other EHR vendors to connect to the blockchain as well, because this solution is not about revenue or market share, it is about patient care and information security and solving a problem that should not exist with what is possible with this technology right now. We have sent out select invitations to several EMR software companies and welcome any of them to join, because those who refuse to do so will only re-create the failure of HIEs and perpetuate the interoperability problem. The interoperability problem is greed, not technical capabilities or security. We hope that our competitors will seize the opportunity the join this initiative and help us put the interoperability issue to rest once and for all. MTBC will be displaying this technology at the innovation section of HIMSS 2019 in Orlando FL, and hope many will join before then.
1 https://www.himss.org/library/interoperability-standards/what-is-interoperability
2 https://www.forbes.com/sites/forbestechcouncil/2018/05/31/the-state-of-interoperability-in-healthcare/#2f4f3092262b
3 https://www.healthit.gov/topic/health-it-basics/health-information-exchange
4 https://www.managedcaremag.com/archives/2016/1/untangling-hie-mess
5 http://www.medicaleconomics.com/technology/blockchain-addressing-interoperability-challenges-healthcare