The indefatigable John Halamka makes a convincing case that "interoperability is implementable today with harmonized standards, appropriate security, and a service oriented architecture using the internet," and that the only thing barring the way to a fully interoperable national EHR system is resources, or incentives — the technology is there.
(This conclusion begs the question: is GE's recently-announced foray into developing a new open standard for EHRs really necessary? The $200 million committed seems to be a drop in the proverbial bucket; as a recovering public health official, I always tend to ask: How many childhood vaccines could you buy with that kind of money instead?)
So, what sort of incentives would move providers to climb on board the interoperable EHR express? The federales have taken at least two approaches thus far:
First, the executive order giving hospitals a free pass for kicking in some dough when physicians in a position to refer business are buying EHR systems. (Not exactly doing land-office business, even after the IRS cleared up a little issue — the executive order created a Stark exception and fraud and abuse safe harbor but hadn't addressed issues raised by tax-exempt hospitals forking over big bucks for the benefit of for-profit medical groups.)
Second, a little MIPPA carrot-then-stick action on the electronic prescription front, with the potential promise of expanding the 2% incentives into other related arenas.
Will these incentives move a lot of docs online? I'm not convinced. Frankly, the hospital community is not exactly looking for ways to spend money these days. I'd like to see the time limits on the executive order extended so that hospitals have a chance to rebound and fund some physician EHR infrastructure. The MIPPA-type or RHQDAPU-type incentives will move docs, as other similar incentives have moved docs and hospitals to report on a million measures.
I'd like to see the federales make some bold moves — which the Obama administration may be prepared to do — and fund EHR infrastructure in the private sector. Directly. By writing some checks. There's at least $700 million of public and private funds on the table, but more is needed. The benefits to be realized are great enough, both in terms of public health and in terms of cost savings to government and other payors (and by payors I mean ultimate payors — those who pay health insurance premiums) that the short-term cost (which is not inconsequential) should be underwritten in the same sort of deficit spending kind of way that FDR used to fund the New Deal.