ASH Clinical News ACN_4.5_FULL_ISSUE_DIGITAL - Page 39

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