By Jim Tate, EMR Advocate
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Last month I spent two weeks in China visiting healthcare sites. My purpose was clear, what had changed in terms of healthcare data interoperability since I was last there 15 years ago? At that time, I spent a few weeks in Daqing during a bitter winter. My task had been to implement a US developed EHR into a community clinic. While that initiative was a success, it also came with a steep learning curve in terms of business culture.
The most recent trip involved a caravan of EMR Advocate, Inc. team members. Our goal was simple; observe and learn. During our travels (Beijing, Xi’An, Chengdu, Guilin, Guangzhou, Maoming) one of the first things I noticed was the level of interoperability that existed throughout financial, transportation, and other domains. I never touched currency, either Chinese or USD, in two weeks. I never saw or used a credit card. All transactions, no matter how large or small, were managed with a phone app. Bullet trains departed on time, sped at over 200 mph, and arrived when expected. Electric vehicles were everywhere and employed technology significantly more advanced than Tesla’s. I rode in a car that not only had external cameras but radar to provide an omnipotent view of the surroundings. What I am saying is that in my experience the concept of interoperability is being hard-wired into the ecosystem of China. This bodes well for the future of their healthcare data interoperability. Standards such as HL-7 and FHIR are important for interoperability, but there must also be a commitment from all sectors for interoperability to thrive.
China’s healthcare system is marked by significant disparities between urban and rural regions. Rural areas lag, frequently lacking the robust IT infrastructure seen in urban centers. This discrepancy creates a substantial challenge in ensuring equitable healthcare access across the nation. Rural regions often struggle with basic IT facilities, making it difficult to implement advanced EHR systems. To bridge this gap, tailored approaches are essential. These may include scalable, low-cost technologies suited to the specific needs of rural communities. Enhancing connectivity and access in underserved areas is crucial for achieving a more equitable healthcare system.
In the US such initiatives as TEFCA are laying the foundation for healthcare data interoperability but there is no mandate to participate. Reimbursement adjustments and other forms of encouragement might not be enough to reach the full scale of meaningful data exchange we deserve. So here is a thought, what if all Medicare providers, to receive any reimbursement, must allow all patient data to be made available to TEFCA? They could choose whether to access the data, but they would have to make it available to receive Medicare reimbursement. Is that too much to ask? Is there enough commitment from Medicare to issue that mandate? This proposal is not a privacy issue as all healthcare payors currently have access to patient data. Is it asking too much to extend that to all providers? Will we see the commitment to interoperability via reimbursement mandates? Sometimes we need a little bit of Central Planning to move us forward.