According to the Rand study on interoperability by Garber et al., the rules for meaningful use payments watered down the requirement for interoperability and connectivity: “The practical effect was to promote adoption of existing platforms, rather than encourage the development of interconnected systems.”
Although 20:20 hindsight may seem unfair, the impact of a Meaningful Use strategy that failed to foster true interoperability saddled our health IT infrastructure with high-priced systems that will prove both difficult and expensive to update to full interoperability.
While the opportunity existed to drive innovation and the potential benefits of shared medical information, provider organizations focused on implementing systems to secure incentive payments funded by HITECH. The government committees that promoted the Meaningful Use rules put in place by the Office of the National Coordinator focused on the current state of technology rather than encouraging the development of new capabilities.
Systems designed before HITECH never valued interoperability as a product feature. In fact, the lack of interoperability significantly raised switching costs, something that served the interest of EHR vendors.
In addition, the rush to deploy EHRs after did not allow these systems to include the health information exchange features that facilitate efficient and complete interoperability. Instead, health information exchange and interoperability became future functionality while systems lacking these capabilities became embedded in provider organizations. The difficulty and expense associated with large system upgrades doomed these provider organizations to many years of crippled clinical systems.