EHR Interoperability Remains Elusive

A lack of standards, privacy concerns, and proprietary and competition issues are just a few of the hurdles hampering the interoperability of EHR data among participants in health information exchanges.

Healthcare providers have made solid progress over the last decade building in-house electronic health records systems to share patient data within their networks. However, interoperability with outside providers and payers remains a significant barrier, according to eHealth Initiative's 10th annual survey of health information exchanges.

Three-quarters of the nearly 200 eHI survey respondents said they've had to build numerous time-consuming and expensive interfaces between different systems to facilitate information sharing, including 68 organizations that said they had to build 10 or more interfaces with different systems. More than 140 respondents cited interoperability as a pressing concern.

Jennifer Covich Bordenick, CEO of the nonprofit, independent eHI, says the results of the survey are "mixed," but adds that it would be a mistake to say that no progress is being made.

"If you look back five years you can see huge leaps in progress, but when you are looking year-to-year it is very slow. It is hard to look at these things in such a small period of time," she says. "The type of problems we are having now is a sign of moving in the right direction. These issues wouldn't have arisen five years ago because we didn't have enough knowledge or we weren't connected enough. Now we're having connection issues, which is a good thing, whereas before we were just trying to convince people that they should do this."

Bordenick says the hurdles in front of interoperability aren't necessarily technical.

"There are proprietary and competition issues where people don't want to share data with other organizations," she says. "While we are all focused on the patient there are a lot of concerns that competitors are going to use their data to their advantage. So competition is one barrier and the other is standards."

"We talk about standards all the time," she says, "but really requiring standards on some of these simple areas would be helpful because right now you have a lot of systems that are proprietary. You have vendors who don't necessarily want to interface with their competitors. So you have competition both with the groups with data, and completion just with connecting. There are all kinds of different politics involved here."

To her surprise, Bordenick says the survey also shows that many HIEs have not yet developed ways to allow patients to enter or view their own data in the health exchanges. As part of the federal EHR Meaningful Use Program, patient engagement is a critical step for providers looking to receive incentive payments for using EHRs.

This could change in future years, as 102 organizations reported that they have plans to offer patients access to their data. However, only 31 organizations currently offer patients access to their information. Even simple patient engagement services, like tools for managing appointments or prescriptions, are rare Bordenick says.

"I would love to know what people in the field think about this," she says. "It's not clear why it's not moving. Is it because somebody else is doing it? Are the exchanges relying on providers, the individual doctors? Somebody has to be doing it. So, is it that we don't know who is doing it or is it that they're not doing it because of privacy concerns?"

"While it's a little disheartening to see such low patient engagement, overall I think we're in a better place than we were last year. Awareness around healthcare reform has helped build the business case for data sharing and engaging consumers."

Bordenick rejects suggestions that the federal government step in to play a greater role in setting interoperability standards. "The last four years have shown us that HITECH has done some wonderful things and Meaningful Use has pushed the envelope, but it has to come from the market," she says.

"The more that customers or consumers or providers [push] for these connections, the more likely it is that vendors are going to do it because we have the capability to do it. Again, it is not about not having the capability. It's about everyone having the same desire to connect."