With the new regime in Washington, there is considerable discussion about what will happen to interoperability. Politics aside, if the President-elect follows his stated policy of dismantling the Affordable Care Act, or even moves to a market-driven approach to HealthCare with minimal regulation, then the question arises, “Is interoperability a viable strategy for hospitals and other healthcare actors in a market regulated healthcare economy?”
From an economic point of view, many hospitals are already under significant cash pressure and are watching capital spending very carefully. The ACA contracts for 2017 are already in place so I expect we’ll see a very cautious outlook during the 2017-2018 period followed by a rather large foot on the brakes in 2018 if the entire ACA patient source of hospital revenue disappears. This could mean deferring or canceling expensive EHR upgrades that involve switching to competitor systems. It will also almost certainly herald an era of acquisition and consolidation as weaker hospitals are bought up by IDNs, and this may potentially allow for economies of scale in EHR purchasing that allow for these larger entities to be more efficient.
For a market that has struggled mightily with interoperability via regulation, consolidation may actually offer a viable way to interoperate in the acute setting, due to the reduced number of entities involved, and their larger IT departments that can afford to pay for specialized labor with experience in standards such as CCDA, FHIR, XDS, and XCA. It does not, however, do much for the pre or post-acute setting where gaining access to records will probably remain a challenge to be addressed by initiatives such as CommonWell or Sequoia over the apparently much longer term.
Where does this leave us? While interoperability is a differentiator for patients in terms of quality of delivery the benefit in cost is neither immediate nor apparent to the patient. If the doctor says the test is needed and the patient does not have the prior exam in hand, then the test is repeated and insurance carries the true cost. Only through an integrative strategy is the patient truly served, at least in the short term.