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Future of systems interoperability for health IT seen in HIMSS demo

The systems interoperability demo at HIMSS shows what early adopters can do. Here’s the rub -- physicians will need more than the HITECH Act’s incentives to join the party.

ATLANTA -- The systems Interoperability Showcase at HIMSS10, the annual conference of the Healthcare Information and Management Systems Society, shows hardware and software from disparate vendors flowing data through systems in live demos, not just the usual canned, polished presentations. In one scenario, a hypothetical female patient shows up at the hospital toward the end of a high-risk pregnancy. Networked computers cleanly push data from admission to labor and delivery on through to discharge -- without involving a shred of paper.

These are the possibilities. The question: Can it be a reality outside the trade show’s cozy confines, in a real-world environment where that scenario now typically begins with a primary-care physician’s staffer having to fish a paper record out of storage, and fax -- or even mail -- the patient’s particulars to the hospital?

“Obviously, that’s not efficient,” said Michael McCoy, CEO of Physician Technology Services Inc., in Nashville, Tenn., and an ob-gyn interoperability expert who sits on several standards groups, the IHE International patient care coordination committee he co-chairs and multiple Healthcare Information Technology Standards Panel committees.

In an interview with, McCoy discussed the future of the systems interoperability technology on display. Similar paperless workflows do happen in a few places, such as in academic health centers with integrated records systems, but for the most part they don’t -- meaning that paper is the medium of choice for the records of roughly a million U.S. births annually.

That’s because so many physicians are still off the electronic records grid, McCoy said. Without incentives to go to electronic health record (EHR) systems -- and when they get them, little more incentive to plug them into their local hospitals’ systems -- things stay the same. The financial incentives in the HITECH Act and the American Recovery and Reinvestment Act of 2009 (ARRA) aren’t really enough to get them on the grid either.

“Why would they want to do it? Until ARRA and HITECH came along, there wasn’t a great incentive for the hospital, and it’s still not a great incentive for the doctor -- especially for the ob-gyn, because we don’t qualify,” McCoy said. “I still believe electronic medical records are the right thing to do for quality of care, for efficiency, for a variety of reasons. But looking to ARRA for funding -- it’s not going to happen.”

While that may sound negative, McCoy is more realist than pessimist. Federal incentive payments may start the U.S. health care system on the way to a world of digital patient records, but two other, stronger factors will push the health care system further toward technology implementation and systems interoperability, he said -- youth and patient demand.

It starts with the physicians who initiate so many patient records. Some physicians, regardless of age embrace the new zeitgeist of EHR systems and their interoperability, McCoy said. Younger providers -- a group he pegs at 40 years old and younger -- embrace and anticipate the kinds of connectivity demonstrated in such venues as the systems Interoperability Showcase. But there is a contingent of older docs who are uncomfortable letting go of paper. Those practitioners will likely wait to be swayed by their patients, who are gradually becoming more informed about the potential benefits of connected EHR systems that follow them from physician to specialist to hospital -- or they may simply retire.

As the population ages out on the physician side over the next 5, 10 or 15 years, computers are going to be in the offices. It will be. So the question is, how can you speed that along?

Michael McCoy, CEO, Physician Technology Services Inc.

“The younger doctors are saying, ‘Why aren’t we more connected?’ and the older group is saying ‘Hey, not so fast, I don’t really want to use this.’” McCoy said. “So, as the population ages out on the physician side over the next 5, 10 or 15 years, computers are going to be in the offices. It will be. So the question is, how can you speed that along?”

The more electronic records come into use, the more consumers will come to expect them, especially as they enjoy the benefits of more efficient care and can see better health care decisions made on their behalf by better-informed practitioners with access to more complete EHR systems. Once EHR adoption hits that critical mass, physicians will view EHRs as more of a competitive edge than a regulatory mandate.

The consumer banking industry is an example, McCoy said. It’s gotten to the point where consumers won’t stand for banks that don’t have ATMs. Now they have taken it one step further, looking to do business mostly with companies that offer the convenience of online payments, to the exclusion of those who don’t.

“If you are using online banking, how many people do you want to actually write a check to?” McCoy said. “If somebody doesn’t take banking online, you really don’t want to do business with them. That’s the same driver that’s going to happen in the physician community, over time. It’s not going to be instant; I’m not naive enough to think it would be,” he said.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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