ONC report highlights interoperability progress and where health systems should focus.
Interoperability remains one of the greatest challenges in health information technology, and resolving these issues holds great promise to enhance innovation. As we move into a new year, a recent report by the Office of the National Coordinator (ONC) for Health Information Technology sheds light on the state of interoperability and where health systems should focus to make continued progress.
Where do the biggest problems lie? The most common reason for not using information received electronically from outside the hospital system is difficulty integrating information into the EHR. The greatest barrier to sending information via electronic exchange is difficulty locating providers’ addresses.
The ONC study, "Variation in Interoperability Among U.S. Non-federal Acute Care Hospitals in 2017," indicates hospitals made significant progress between 2016 and 2017. Yet challenges still exists. Among the barriers to health information exchange, nearly six in 10 hospitals reported challenges exchanging patient health information across different vendor platforms, up from five in 10 in 2016.
The report measures progress in four areas (or domains as the report calls them) related to the exchange of electronic health information:
"Engaging in all four domains of interoperability is critical to ensure that clinicians have the information they need at the point of care," according to the report. "Eighty-three percent of hospitals that engaged in all four domains of interoperability reported having information electronically available at the point of care. This is nearly 30 percent higher than hospitals that engaged in three domains."
Following are excerpts from the report, providing further insight into progress and sticking points:
Highlights of ONC Report
- Hospitals that engaged in all four interoperability domains increased by 41% since 2016
- Hospitals that engaged in four domains of interoperability were over three times more likely to have information electronically available than hospitals that only send and receive summary of care records
- Nearly 3 in 10 small, rural, and Critical Care Access hospitals (CAHs) can send, receive, find, and integrate summary of care records in 2017
- Small, rural ,and CAHs increased their rates of engagement in four interoperability domains by 50% between 2016 and 2017
- Small, rural, and CAHs trail their counterparts across all four domains of interoperability
Why Hospitals Don't Use Patient Info from Outside Sources
Difficulty integrating information into the EHR was the most common reason reported by hospitals for not using health information received electronically from sources outside their health system. But that's not all.
Lack of timely information, unusable formats, and difficulty finding specific, relevant information also made the list, according to the 2017 American Hospital Association Annual Survey, Information Technology Supplement.
Among the explanations health systems provided for rarely or never using patient health information received electronically from providers or sources outside their health system, along with the percentage of hospitals citing this rational included:
- Difficult to integrate information in EHR 55%
- Information not always available when needed (e.g. timely) 47%
- Information not presented in a useful format 31%
- Information that is specific and relevant is hard to find 20%
- Information available and integrated into the EHR but not part of clinicians' workflow 16%
- Do not trust accuracy of information 10%
- Vocabulary and/or semantic representation differences limit use 7%
What Are the Greatest Barriers to Sending Info via Electronic Exchange?
Hospitals pointed to an interesting issue when asked to explain their primary inability to send information though an electronic exchange: Difficulty locating providers’ addresses. The combined reasons, ranked in order regardless of hospital classification (small, rural, CAH, or national), include:
- Difficult to find providers' addresses
- Exchange partners' EHR system lacks capability to receive data
- Exchange partners we would like to send data to do not have an EHR or other electronic system to receive data
- Many recipients of care summaries report that the information is not useful
- Cumbersome workflow to send the information from our EHR system
- The complexity of state and federal privacy and security regulations makes it difficult for us to determine whether it is permissible to electronically exchange patient health information
- Lack the technical capability to electronically send patient health information to outside providers or other sources
Additional Barriers Exist
The report also details other barriers related to exchanging patient health information, citing the 2017 American Hospital Association Annual Survey, Information Technology Supplement:
- Greater challenges exchanging data across different vendor platforms
- Paying additional costs to exchange with organizations outside our system
- [Need to] develop customized interfaces in order to electronically exchange health information
"Policies aimed at addressing these barriers will be particularly important for improving interoperable exchange in health care," the report concludes. "The 2015 Edition of the health IT certification criteria includes updated technical requirements that allow for innovation to occur around application programming interfaces (APIs) and interoperability-focused standards such that data are accessible and can be more easily exchanged. The 21st Century Cures Act of 2016 further builds upon this work to improve data sharing by calling for the development of open APIs and a Trusted Exchange Framework and Common Agreement. These efforts, along with many others, should further improvements in interoperability."
Mandy Roth is the innovations editor at HealthLeaders.
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