A Fully Government-owned Standard EHR: Killing Oligopoly for Interoperability | Sherpas in Blue Shirts

Epic Systems, Cerner, AllScripts, McKesson, and AthenaHealth…if you have heard these names, you likely know what EHR stands for. I don’t mean the non-acronym form, Electronic Health Records, but what it actually stands for – oligopoly, sunk billion dollar investments, platforms that don’t speak to each other, and that look on physicians’ faces when their shift “ends” and coding starts.

When President Obama famously daydreamed the US$80 billion a year savings from the EHR nudge, many were cynical that it would ever come to fruition. Six years later, while EHR in the U.S. is an over US$5 billion-a-year industry, the savings are nowhere in sight, and the cynics are sniggering, “we told you so.” Sadly, while the doomsday predictors are having a field day gloating over the sorry state of affairs, the folks on the technology and policy sides are ruing a great opportunity lost.

The issue was never with the business case for EHR – a standard system of record aiding providers and physicians in medical decision support. What could possibly be wrong with that vision? Billions of dollars of sunken investments and a multiplicity of protected standards later, sitting on the books of large providers are bloated monsters who scare away any attempt at efficiency, data intuitiveness, and interoperability.

Frankly, the current debate on interoperability is as farcical as it can get – the same bunch of folks who created the virus are now trying to invent a vaccine for it. Who paid for the virus? Subsidy did. Who will pay for the vaccine? Irrelevant. If the debate continues the way it is going, what you think will be a vaccine will actually be an upgraded, non-resistant version of the virus. With the federal committee on interoperability largely staffed by big EHR vendors, we have a situation akin to employing a cat to guard the milk.

My suggestion? Let’s not fight the cats here. The cacophony will be way too unbearable. Instead, here is a solution (and warning… radical suggestion alert!)

  • Interoperability
    • Government should create its own EHR system
    • It should create a separate fund and an agency (akin to CMS)
    • The new-EHR should be cloud-based
    • An EHR subsidy should be given only for those providers that move to this government EHR
    • Eliminate Health Information Exchanges (HIEs) and Healthcare.gov. Hoping HIEs would solve for data portability and interoperability was always a futile attempt at putting lipstick on pigs.
  • Technology and build
    • Have an open bid managed by a consortium comprised of practitioners, providers, and top tech innovators from Silicon Valley and the healthcare industry
    • Selection of the technology platform should rest only with tech representatives
    • Design thinking should be led by practitioners and physician representatives
    • Development and implementation can be outsourced to EHR vendors.
  • Solving for costs sunk by providers in EHRs: With billions already invested, what is the incentive for providers to even consider a new EHR, unless they are forced to do so?
    • Government should subsidize (yes, another subsidy) all migration costs to the new EHR
    • Since the new EHR will be cloud-based, storage costs will be significantly reduced. However, providers will have to pay a fixed fee each year to stay licensed
    • Personnel training costs will be hugely reduced over the years as this new government EHR can simply be part of curricula at all medical and nursing schools.

Reality check here…what I have just suggested will kill an industry and open the government to multiple litigations by the large EHR vendors. I never suggested this would be easy. But, could it be done by force of political will and legislation? The answer is a resounding, “Yes.”

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