While they conspiracy theories about why EMRs aren't all that interoperable are a lot of fun to engage in, they are almost completely wrong. There are some real reasons why EMRs have the issues they have with interoperability. Let's start with some history.
First, if one goes back 20 years before meaningful use, before the enforcement of HIPAA we have today, EMRs were even less interoperable than they are now. The EMR landscape was the wild, wild, west and EMR companies were far more concerned with adding features and tools for their respective client base than they were exposing data to consumption by outside entities. And, there weren't really any outside entities that cared about interfacing with some EMR. Therefore, the lack of interoperability didn't register that much, and most doctors just didn't care since many still kept paper notes anyway.
Fast forward a few short years and we now have the government mandating the use of an EMR by promising reduction in reimbursement through MCD/MCR. Suddenly, everyone and their brother is buying an EMR and new EMR programs are appearing left and right. Two major problems then ensue. First, too many practices for some reason believed the $44,000 stimulus was somehow "free" money and all they had to do was buy whatever EMR they wanted to buy. Second, as before mentioned, EMRs popped up everywhere as various venture capitalists hired software development firms all over the world to quickly stand up an EMR program. Most of this work was poorly done because of how rushed many of the projects were and the use of foreign development that did not have a full understanding of US healthcare needs.
Either way, it was made clear to EMR companies that meaningful use was Top Priority. Interoperability not only went to the backburner, but it also wasn't even thought of. All those different EMRs used vastly different technologies to accomplish their goals. Some used Microsoft technologies. Examples would include Amazing Charts and NextGen. Others used well-known open-source technologies. Examples include eClinicalWorks and PatientNow. Some used technologies that are closed source but were competitors to Microsoft. Examples include AMD and Centricity.
And on top of the variously different technologies, there were developers around the world reading the meaningful use documentation and coming away with their own interpretation on how to accomplish meaningful use. As the old saying goes, ask 5 developers the same question and you'll get 11 different answers. In the end you have hundreds of EMRs, some on prem some online some both, that implement meaningful use in a way the government approves but do so in vastly different ways regarding how data is handled and stored.
Interoperability became that much further away.
Eventually, organizations such as HL7 came around to take on the challenge of interoperability along with some small-time guys like myself. HL7 provides a common framework of data transmission using file messages that are more-or-less fill in the blank.
Today, interoperability is the last great frontier for EMR systems. The imminent threat of meaningful use has mostly dissipated. People have all these systems in their offices now - EMR, PM, other third-party entities - and they want them to talk to each other. Things are getting better and various systems are becoming more open. But we aren't quite there, yet.
Is the lack of interoperability some massive conspiracy? No, of course not. It just wasn't a priority until recently.
JamesNT
Last edited by JamesNT; 10/28/2022 3:12 PM.
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