a multitude of independent entities, would go a long
way toward facilitating adoption of these new tools.
Ultimately, given the right environment, a separate
marketplace for clinical apps on health care platforms
will develop in which applications can be made available to multiple end users.
Access to all pertinent sources of clinical data is
essential to appropriating the full benefit from big
health care data, and for this to happen, the primary data held in EHRs will need to be fully leveraged.
Unfortunately, health systems that have created and
implemented this type of big data platform are already
seeing private EHR vendor attempts to govern and control the information flow by blocking access to clinical information for analytics so that they can control
and monetize the use of data housed in their products.
Such attempts by various private companies to block
information could prevent physicians from continuing to use these powerful tools for improving patient
care and quality, or, at the very least, greatly limit
their value. If left unchecked, this trend will have a
chilling effect on innovation and will slow progress
The advantages of the interoperability provided by
PaaS and the improvements to health care it promises
merit further investment in this technology as well as
regulatory support from the federal government. In
an August 14, 2014, letter to Sen. Ron Wyden (D-OR)
and Sen. Charles Grassley (R-IA), ACS Executive Director David B. Hoyt, MD, FACS, expressed the need for
information held in EHRs, registries, and other primary sources to remain available or be made available in a secure, cloaked or de-identified, standard format for the purpose of data analysis. This letter was
sent in response to a request for information on how
to advance the availability and utility of health care
data from then Senate Finance Committee Chairman
Wyden and Finance Committee member Grassley.
In fact, the issue of information blocking is receiving growing attention in Washington. In July 2014, two
physician members of the House Energy and Commerce Committee, Rep. Phil Gingrey (R-GA) and Rep.
Bill Cassidy (R-LA) spoke out on the issue, going so
far as to call out individual EHR vendors for the practice and suggesting that the lack of interoperability
bet ween EHRs that have been supported with billions
of taxpayer dollars is equivalent to fraud. 9 The Energy
and Commerce Committee has undertaken an ambitious multi-year effort to ensure that federal laws and
regulations keep pace with advances in medicine in
many areas, including “unleashing the power of digital medicine.” 10 The ACS has tried to support these
efforts by providing information on multiple occasions.
More recently, the fiscal year 2015 spending bill
enacted by Congress in December included report
language urging the Office of the National Coordinator for Health Information Technology (ONC) to
certify only EHRs that do not block health information exchange. 11 The report language further called
on the ONC to provide a detailed report to Congress
on the problem of information blocking, including a
comprehensive strategy on how to address the issue.
Although such report language is nonbinding, it is
seen as a strong statement on the intent of Congress.
Federal agencies, which receive their funding from
Congress, frequently use these reports as guideposts
for developing rules and regulations. If that proves to
be the case and ONC follows Congress’ instructions,
the report and strategy recommendations could be
released in the spring.
How surgeons can support
big data ecosystems
ACS Fellows and members can take a number of
College-supported steps to realize the full potential of a data ecosystem. Actions surgeons may take
to support the data ecosystem include the following:
• Surgeons must first understand and engage in the design
of data ecosystems larger than the EHR “space.” This
understanding ideally means surgeons will have a role
in optimizing data and its multiple repurposing—both
on the input and the output side of the ecosystem.