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AHA Report Highlights Substantial Barriers to Provider Interoperability

October 12, 2015
by Heather Landi
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While hospitals are investing more in health information technology (HIT), a lack of interoperability among electronic systems is among the most pressing issues facing healthcare stakeholders today, according to a recently released report from the American Hospital Association (AHA).

The report highlights the significant strides hospitals have made in recent years in the adoption of electronic health records (EHRs), as 75 percent of hospitals employ at least a basic EHR, up from only 9 percent in 2008. The AHA estimates that, between 2010 and 2013, hospitals spent $47 billion annually on HIT.

However, while many hospitals are able to use their current EHR for some information exchange activities that promote interoperability, such as finding, sending or receiving information, only 23 percent of hospitals can do all four information exchange activities (find, send, receive and use). And, only 40 percent of hospitals can use the information they receiving, meaning that the records are integrated into the hospital’s EHR without the need for manual data entry.

“EHRs have become a critical part of the infrastructure needed to improve care coordination, engage patients and improve public health. However, the nation is still a very long way from fully tying them together to help providers meaningfully use information at the point of care to help patients get better and save money. This lack of interoperability is costly to patients, taxpayers, hospitals and others,” according to the authors of the AHA report.

 The report cites a Premier, Inc. and eHealth Initiative survey of accountable care organizations (ACOs) in which 95 percent of organizations surveyed cited interoperability as a major obstacle to effectively using and meeting the potential of health IT.

The AHA report also says that the lack of interoperability across healthcare providers is a barrier to advancing patient engagement and it also impedes reporting of public health, quality and safety data.

Confronted with poor interoperability, hospitals typically build or license interfaces to import and export data from both internal and external sources, such as the hospital’s EHR, lab, admit/discharge/transfer, medical devices as well as outside labs. According to the AHA report, this means that a single hospital may employ a few dozen interfaces, while a large health system with many sites can employ hundreds or even thousands of interfaces.

“Truman Medical Centers, a two-hospital, 600- bed, not-for-profit health care system in Kan­sas City, Mo., has more than 55 connections to external organizations with which it must interface to transmit health data information, according to Mitzi Cardenas, senior vice president for Strategy, Business Development and Technology. Cardenas estimates that the average cost of an interface is $10,000 to $20,000,” wrote the authors of the report.

Some hospitals also have turned to HIEs to overcome interoperability barriers, yet the costs of building interfaces and questions about the self-sufficiency of HIEs when federal grants end are significant challenges, cites the report.

And, looking ahead, as provides move toward implementation of care coordination models, far more complicated interfaces will be necessary to accommodate data exchange.

“Hospitals have tried to overcome interoperability barriers through the use of interfaces and HIEs but they are, at best, costly workarounds and, at worst, mechanisms that will never get the coun­try to true interoperability. While standards are part of the solution, they are still not specified enough to make them truly work,” the report states. “Clearly, much work remains, including steps by the federal government to support advances in interoper­ability. Until that happens, patients across the country will be shortchanged from the benefits of truly connected care.”




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