“Interoperability continues to be the most vexing problem in the industry," says Joseph Welfeld, president of The Welfeld Group, which provides market strategy, business development and advisory services to emerging healthcare technology organizations. "It is a particularly difficult issue for small practices since vendors tend to charge a significant fee on a case-by-case basis to link to another system.”

Just last month (February), the Office of the National Coordinator (ONC) released an "Interoperability Roadmap,” describing the current market and issues in interoperability, such as the importance of clarifying HIPAA to reduce confusion – for example, there is such thing as HIPAA certified software. And as federal and state laws have been major roadblocks to interoperability, the report suggests that states become more involved in inoperability to avoid 50 different variations to accommodate various regulatory conformities.

“True interoperability will happen when the Federal Government makes it a standard requirement for EMR certification," Welfeld says. "It is currently a voluntary process and competition among vendors means that they don't play well with each other.” 

The remaining barriers to interoperability for the physician with small practices – aside from technical issues that can be dealt with a one-off basis – are the cost of Interoperability, which includes both the technical cost and the resource or consultant costs, Welfeld says. This can get exacerbated if a hardware or software upgrade to the EMR is required or if the practice works with more than one hospital, although some of these costs can be offset by a hospital and through more effective negotiations with vendors.

The ONC is accepting public comments on the draft Roadmap until April 3. As the issue continues to get hammered out, one thing is clear: EHRs and providers need to connect and share information with one another. How and when it is going to happen is another question.