The Value of EHR Interoperability that Money Can't Buy

Marc WineWhen I was teaching my Medical Informatics class in graduate school, I would introduce the course with a story. It was about the differences between my Uncle Lou, a former Chief of Orthopedics at the Massachusetts General Hospital back in the 1960s, and the concierge doctors of today.

Uncle Lou lived in a modest studio apartment on Beacon Street in Boston. Any patient with a medical need could receive care from Uncle Lou, whether they could pay or not. That was then. And now?

Today, individual doctors and related physician networks practicing concierge medicine conscientiously pursue the marketing and business tactics of 'commodification' of patient care - to ease their workload, target higher income bracket consumers, and maximize their profits.

There seems to be something missing in our national debate about health care and the use of health information technologies (IT) in this marketplace.

Do we want a more 'open' healthy society, or a more closed system? What role should markets play in public health and medical sociology? How do we decide which EHR solutions to acquire? Should we be looking more closely at open source alternatives versus proprietary programs. Should money, quality of care, or some other non-market values determine what's best for the patient?

This cuts to the heart of the debate. Consider the hospital that chooses to not pay an expensive proprietary EHR vendor for the enhanced code required by a doctor in order to get the latest real time knowledge for treating a patient's disease.

Peter Groen

By treating EHR software code needed to properly care for patients as an expensive proprietary commodity, the hospital and vendor competing in the marketplace for increased profits have failed to put the interests of the customer or patient first. They are willing to play with the 'life or death' situation patients may be facing in order to maximize profits by withholding access to the software code – their 'closed' proprietary code.

I contend there is a need for further publically debate the issues of value, responsibility, and trust patients can place in the way health IT software is handled and sold. Do we want a completely 'free market' approach to developing, sharing, and selling EHR solutions? Do we want to further encourage the growth of a marketplace that supports the use of prohibitively expensive, 'closed' proprietary EHR software code? Code that is not 'open' or interoperable?

Or, do we want to encourage the growth of a health IT marketplace that supports the use of more 'open' source code, open standards, open data, and open access to knowledge that is focused on the interests of patients and their health first. Do we want to see more 'open' communities in the healthcare sector driven by something other than a purely profit-driven economic business model? A healthcare market driven more by 'human values' than the value of he dollar.  

Encouraging the unfettered commoditization and procurement of 'closed' proprietary EHR system and health IT software code may adversely effect our healthcare system in various ways -  from producing sub-standard code, throwing up barriers to interoperability and connectivity, slowing the adoption of health information exchange (HIE), increasing costs unnecessarily, slowing the pace of innovation, endangering patients' lives, and more.

We need a moral dimension added to the process of acquiringing EHR systems - a new conversation about an approach that encourages the use of alternative 'open source' software solutions, 'open' business models, open semantic interoperability, and putting the interests of patients first, resulting in better quality outcomes across 'our' national health care system.