Earlier this year, ”The Daily Show” host Jon Stewart aired an entire segment on the lack of interoperability between the electronic health record (EHR) system used by the US Department of Defense (DOD) and that of the US Department of Veterans Affairs (VA). Stewart pointed out that, while this might be expected between competitors in the private sector, it’s “not the relationship you expect from the part of the government which takes care of our disabled veterans and the part of the government that creates them.”
Gallows humor aside, Stewart’s nearly-seven-minute segment had an effect. Following subsequent coverage by Nextgov.com —“Did Jon Stewart Foil the Pentagon's Health Records Plan?”— it appears the Military Health System has halted their plans to beef up the Armed Forces Health Longitudinal Technology Application (AHLTA), possibly opting for the Veterans Health Information Systems and Technology Architecture (VistA) to become the EHR for both the DOD and the VA.
What does this all mean? First, the idea of digital health being a means to improve health care has gone mainstream. Second, you no longer have to be in the health care industry to realize there is an inherent need for improved interoperability.
A Common Goal to Bring Data Interoperability to Health Care
It’s great to see efforts toward better health care data interoperability in the private sector, especially by the recently formed CommonWell Health Alliance, a non-profit organization represented by athenahealth, Allscripts, Cerner, Greenway, McKesson and RelayHealth. These health IT vendors are working to create industry-wide access to patient health information by the use of existing unique identifiers, such as a patient’s cell phone number, e-mail address or driver’s license. This effort by six of the nation’s more prominent health IT providers will certainly go a long way toward fostering EHR interoperability and leveraging the value of digital patient data.
A Call for Unique Patient Identifiers
The government could also play a key role in enabling interoperability in the private sector, but there’s a missing piece: Congress has actually prohibited the Department of Health and Human Services (HHS) from establishing standards for that unique patient identifier. In his petition to the Obama Administration, health IT evangelist, Brian Ahier points out that Congress passed the Health Insurance Portability and Accountability Act (HIPAA) in 1996, which included provisions requiring HHS to “adopt national standards for electronic healthcare transactions” and “a standard unique health identifier for each individual, employer, health plan, and health care provider for use in the healthcare system.”
But, in 1998, Congress passed a law that prohibited HHS from spending any funds to promulgate or adopt any final standard for an individual’s unique health identifier until legislation is enacted approving the standard.
The Healthcare Information and Management Systems Society (HIMSS) has identified cost savings and safety benefits associated with a unique patient identifier and has recommended to Congress that they should permit HHS to develop standards—especially if doing so could increase efficiencies and prevent medical errors. As further pointed out by HIMSS:
“in the absence of a nationwide patient data matching strategy, the states, HIEs, large health plans, various consortiums, and individual electronic health record vendors have had to develop individual patient identity solutions that do not necessarily work well across systems. As our nation moves forward with greater urgency toward system-wide health information exchange, this essential core functionality to ensure the accurate match of a patient with his or her information remains conspicuously absent. The multitude of different solutions and the lack of a national coordinated approach pose major challenges for our health information infrastructure and result in millions of dollars of unnecessary costs. Patient safety, privacy, and security depend on getting this core element right, and soon."
While the creation of a national unique patient identifier may not be in the immediate future (the petition had just over 100 signatures of the 100,000 required at the time I started writing this and is no longer listed on petitions.whitehouse.gov), it could complement and amplify the efforts of the CommonWell Health Alliance.
Maybe if Jon Stewart were to feature the equally challenging situation that the private sector faces with health care data interoperability, we just might see a change in government position and actions here, too.
Paul Sonnier is the Head of Digital Health Strategy at specialty consulting firm Popper and Company, Founder of the 17,000+ member Digital Health group on LinkedIn, an XPRIZE judge for the Nokia Sensing XCHALLENGE, and a mentor at digital health startup accelerator Blueprint Health.