FEATURE
Despite efforts by the U.S. Department
of Health & Human Services (HHS) to
make EHR information more readily ac-
cessible and useful for patients and clini-
cians, EHRs have, thus far, failed virtually
all tests of interoperability.
There are multiple reasons for this
overt failure, according to health policy
and EHR expert Julia Adler-Milstein,
PhD, from the University of California
San Francisco School of Medicine.
“I think the source of the problem is that
we put EHRs in place first, and then tried
to figure out how to link them up,” she said.
“EHR systems were not designed with that
capability upfront. Also, there are no strong
incentives for providers and vendors to
overcome the complexity of making these
systems interoperable.”
If the EHR system is having communi-
cation difficulties, switching vendors is no
simple task. Changing systems, particularly
for an entire hospital system, is costly,
complicated, and disruptive.
“Lock-in is a problem, and it’s not a
competitive market in that sense,” Dr. Adler-
Milstein explained. While hospitals and pro-
viders can switch vendors, “you don’t want
to do it if you don’t have to, so mostly people
make do and tweak the system they have.”
At her institution, she noted, there are
“hundreds of people” just working to im-
prove their medical record system “because
I think the sense is that Epic [the market
leader in EHR software] can only go so far.”
In November, the U.S. Department of
Veterans Affairs (VA) announced a plan to
spend approximately $10 billion for a new
EHR system from Cerner Corporation. 13
Interestingly, though, Dr. Zelenetz cited
the VA’s existing system as an EHR success
story: “If a patient has an appendectomy
at the Bronx VA, he can walk into the Palo
Alto VA, and the staff can open his record