Interoperability – the ability of physicians and health care systems to share electronic versions of patient information.
The portability of today’s patient’s electronic medical record is not anywhere as easy or transparent as copying the chart, handing it to the patient and letting them take it to a new provider – a 1980 technology.
It turns out that unlike analog records, digital records stored in proprietary formats are not easily shared – despite the explicit statement in the federal funding of EHR systems that they “Improve care coordination, and population and public health.”
Software companies that acquired millions of taxpayer’s dollars to develop proprietary software and then additional millions for the “rent” of annual maintenance and upgrades dragged their feet in creating translators allowing information to pass seamlessly between health systems and physicians using different EHRs.
Thirty plus years, billions of dollars and countless wasted hours of physician and other providers time later and we still cannot duplicate let alone improve the 1980 approach.
You would think that these titans of software, with revenues in billions of dollars, would be able to provide a mandated system requirement to share information between providers.
The current excuse for lack of transportability – the Stark law, specific federal anti-trust regulations.
This legislation written last century prevents ‘kick-backs’ between referring physicians or entities.
Patient referrals should not result in an exchange of “value” between the sender and receiver; that prevents a conflict of interest and is a guide rail for meeting our fiduciary responsibilities to patients. But what value are we exchanging when we transfer patient records?
Government and business agree, your healthcare data has value.
But who is the owner of that data? It turns out if you consider both the government’s and health systems’ position, the data is owned by them, not the patient.
Here is a portion of a letter sent by a software executive  to the Office of the Inspector General for Health and Human Services regarding interpretation of the Stark Law.
“In healthcare, however, because the transfer of patient data occurs most frequently in the context of a care referral, any accompanying transfer of value is prohibited under the Stark Laws and/or the Anti-Kickback Statute.
As a result, the owner/curator of quality data is obligated to assume the cost of electronic transfer of information to a recipient.
So because it costs a doctor money to create a patient’s electronic records, they claim that the doctor is “transferring value” to a different doctor by sending them the record. What a diabolical claim.
However, from my knowledge of computers, these health records should be kept in a central database by some company that isn’t involved in medical care, just databse administration. Then any doctor with the proper authorization could access a patient’s medical file.
This is the ideal: a central repository of patient data that can be accessed by any of the patient’s doctors. This would be supremely useful for emergency responders as well.
The beneficiary of the work and the infrastructure investment necessary to curate that data and enable the secure and efficient transfer of the data—the recipient—is prohibited from paying fair market value for that work and investment.
This paradigm, which forces the curator of data to pay for the privilege of sending data electronically to a recipient, operates as an effective economic disincentive to information sharing in healthcare.
That disincentive, of course, burdens clinicians and impedes efficient delivery of high-quality care to millions of Medicare beneficiaries.”
Here is the same author quoted in Modern Healthcare,
“There is a cost associated with building and maintaining the technical infrastructure. …Our proposal would allow for the recipient of valuable data to compensate for the real cost incurred in curating and sending that data electronically.”
Who would receive this compensation? The same software people who were supposed to provide this functionality previously; greater “administrative” costs will let these companies once again dine on our dime.
But there is a greater injustice perpetrated. Who decided that this valuable data, belongs to the health system?
Who owns your healthcare data?
More than any information we have, our healthcare information is deeply personal and ours alone.
If the patient owned their data, there would be no exchange of value between sender and receiver, the value would be retained by the patient. We would not need to carve out a regulatory exception or write more regulations.
Healthcare data is collected from our speech, our blood, our tissue or the assessments of physicians in our “employ,” (after all we are paying for the service).
When was it decided that this data belonged to the health system “collectors ?” At least Facebook, Google, and Apple provide terms of service that we don’t read, here there is no pretense of consent at all.
Physicians have no problem sharing information, ask any physician whether he gets a note from the doctor he recommends to his patients; because if not, he finds another consultant.
To understand this data “gold rush, follow the money.
It leads back to software vendors looking for a “rent hike,” and health systems that are trying to retain “lives at risk” from their competitors by making transport of records more difficult.
The first step is to say as a matter of principle, that healthcare data is the property of the individual to share as they believe necessary. Who will stand for our rights?