For the past few weeks, Epic’s opposition to the Department of Health and Human Services’ (HHS') interoperability and information blocking rules has dominated the digital health news cycle and continued to draw ire from the industry.
Rightfully so, much of the focus has been on patients’ rights to their health data—especially given Epic CEO Judy Faulkner’s apparent opposition to making patient data access easier.
But much less attention has been given to solving for provider-to-provider information exchange, despite the enormous challenges and barriers that still exist in that arena.
With the Trusted Exchange Framework and Common Agreement and information blocking rules, the Office of the National Coordinator for Health IT (ONC) has an undoubtedly admirable goal: Create a “single onramp” for nationwide health information exchange and interoperability using a variety of policy levers.
What’s missing from the policy levers, however, is an understanding of the role and nature of networks, also called multisided platforms (MSPs), or what most in healthcare will recognize more generally as health information exchanges. Specifically, how networks create value, how they compete and what they need to make various interoperability use cases a reality.
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Also missing from consideration? The underlying issue that, with these policies, the ONC is attempting to regulate a market into existence—and with this approach comes a ripple of negative effects standing to undermine the very result the ONC is trying to achieve.
MSPs: Policy design versus time to develop
While they may be dominant in their respective markets today, Amazon, Uber and Lyft and Airbnb—all examples of networks/MSPs—were certainly not overnight success stories. Each network took time to grow, amass users and evolve into the well-oiled versions we know today.
Similarly, to build a successful network for health information exchange, any policies or implementation frameworks must provide enough time and flexibility for the networks to develop and scale. Unfortunately, this is not the case in the latest ONC guidance, which has the first group of Qualified Health Information Networks up and operating by August 2020.
This accelerated timeline does not provide nearly enough of an on-ramp for proper network setup and development, let alone growth and optimization. And this isn’t the first time the industry has seen this play.
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For instance, while e-prescribing between doctors and pharmacies may now be routine (85% of all prescriptions were e-prescribed in 2018), remember that Surescripts—the health information network responsible for routing the majority of the country’s e-prescriptions—started on its interoperability journey nearly 20 years ago and took about a decade to scale.
Policy design versus market demands
On top of a lacking understanding of MSP development and optimization, perhaps the biggest issue with the federal guidance is that ONC is attempting to regulate a market into existence.
This is a problem because, outside of the growing patient desire (PDF) for health data access and utility, there hasn’t been sufficient industry demand for this level of information exchange, as evidenced by a lack of willingness to pay.
Case in point: Almost a decade after the U.S. government invested more than $35 billion in the creation of the meaningful use program to spur electronic health record (EHR) adoption, a seamless exchange of health information between providers is a rarity, despite the fact that the majority of providers today use an EHR.
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Moreover, under ONC’s information blocking rule, health systems, EHRs and health information networks would be required to “open up” their APIs to improve the exchange of health data. The problem with this is networks compete on a variety of measures, including price, business model, quality, governance and how they uniquely facilitate the exchanges between users.
By attempting to commoditize and regulate the means and methods of health information exchange (e.g., through fees), the ONC is establishing a network value “ceiling” and thus effectively short-circuiting the way networks compete and develop.
Lastly, by removing an economic upside for MSP developers/operators, rather than having the “best network win” in the market, the industry may be left with: 1. a handful of “zombie” networks (unable to invest in improving the quality and value of exchange), or 2. a monopoly or duopoly situation, as smaller regional health information networks find themselves unable to compete with larger, national networks.
More time, fewer constraints: Interoperability depends on proper MSP development
Creating a single on-ramp for nationwide health information exchange is a commendable goal, worthy of industry action and investment in a solution.
But taking a rushed, “one-size-fits-all” approach to MSP development—one that stands to undermine the very goal the policies were designed to achieve—is not the right way to do it.
Will MSPs be the prescription nationwide interoperability needs to succeed? Only time will tell.
Seth Joseph is managing director of Summit Health, a recognized expert in digital health technology and author of several articles on the space. He has spent more than a decade helping companies successfully bring novel digital technology to healthcare markets. Previous to founding Summit Health, Seth led corporate strategy at Surescripts. Prior to Surescripts, Seth led eHealth strategy for Caremark, part of CVS Health.