Hospitals have made advances in information sharing between departments as well as with other care partners, patients and public agencies, yet critical infrastructure and technical barriers continue to constrain the sharing of patient information and need to be addressed to support interoperability in a real-world environment, according to a recent TrendWatch report from the American Hospital Association (AHA).
Hospitals have invested substantially in health IT and electronic health records (EHRs), with a goal to increase their capacity for sharing data electronically with patients and care partners. The AHA brief notes that through the Medicare and Medicaid EHR Incentive Program, U.S. hospitals have been eligible for financial incentive for adopting and using EHRs in accordance with federal meaningful use criteria.
Results from the AHA’s Annual Survey Information Technology Supplement indicates that hospitals have increased the ability to send and receive clinical care information through their EHR.
“Between 2011 and 2014, during Stage 1 and the first year of Stage 2 of the EHR Incentive Program, hospital information sharing in both inpatient and ambulatory care settings with providers outside the hospital’s system improved markedly,” the AHA brief states.
Specifically, in 2011, hospitals electronically exchanged clinical/summary of care records with 22 percent of hospitals outside their system and that increased to 57 percent in 2014. And, in 2011, 37 percent of hospitals electronically exchanged clinical/summary of care records with ambulatory care providers outside their system and that increased to 60 percent in 2014.
According to an AHA analysis of the AHA Annual Survey IT Supplement data, hospitals employ a number of methods to send data electronically with other providers as 87 percent of hospitals routinely send a summary of care record by secure messaging, 82 percent do so through eFax using their EHR, 78 percent send a summary of care record through a health information exchange and 70 percent use a provider online portal.
However, the AHA brief notes that the standard information currently included in summary of care documents that are required in the EHR Incentive Program often does not meet the needs of clinicians.
“As a result, hospitals must rely on custom programing and additional configurations in order to ensure sufficient patient information is shared for care decisions. With the appropriate standards in place, providers could obtain the data they need without additional work-around solutions,” the AHA stated.
The AHA analysis also notes that in areas where health information exchanges (HIEs) are operational, 75 percent of hospitals participate in HIEs. “This is a significant increase over reported participation in 2011, when 22 percent of hospitals were active in an HIE,” the AHA brief states.
And, the AHA analysis indicates that hospitals have significantly increased patients’ online access to their health information as 89 percent of hospitals provided patients the ability to view information from their medical record online in 2014, up from 43 percent in 2013. Also, 80 percent of hospitals provided patients the ability to download information from their medical record in 2014 compared to 30 percent in 2013.
“A growing percentage of hospitals also are offering the option for patients to perform functions outside of reviewing their medical record, such as requesting prescription refills and scheduling appointments” the AHA states.
Despite significant hospital investment in IT infrastructure and EHRs, there are still critical barriers that impede the effective flow of information, according to the AHA report. The lack of compatibility of products across vendors makes the effective and efficient exchange of health data an ongoing challenge.
According to an AHA survey, hospital leader respondents reported a number of issues when trying to electronically send, receive or find patient health information with other care settings. Sixty-two percent of respondents reported that the intended recipient did not have an EHR or other system capable of receiving the data and 60 percent reported that other providers have an EHR but are not capable of receiving information electronically.
Also, 46 percent reported that it is difficult to find provider’s electronic address. Further, more than a quarter of hospitals reported that they are required to pay additional costs to send or receive health data, which provides a disincentive to information sharing. Also, a quarter of hospitals find the workflow cumbersome when sending information from an EHR system.
“According to the Office of the National Coordinator for Health IT (ONC), most complaints of information blocking are directed at vendors and developers, some of whom charge high fees for users to send or receive data or for development of the interfaces necessary to allow two different IT systems to exchange data. Additional concerns relative to vendors relate to development practices that prevent or make it difficult for EHRs to connect with products and IT systems made by other companies,” the AHA report stated.
The AHA report also notes that Stage 2 of the EHR Incentive Program increases the requirements for information sharing and Stage 2 rules require use of standards that are not yet in common use. “Providers need the technology and infrastructure that will allow their IT systems to communicate effectively. For example, providers must often create a separate interface for each department’s IT system to allow information to flow into the hospital’s EHR, even within the same hospital,” the AHA stated.
With the average cost of a typical interface ranging from $10,000 to $20,000 and interfaces for more complex functions may cost as much as $75,000 and these costs make it difficult for some hospital to afford the investments necessary to share seamless information sharing, according to the report.
The AHA asserts that mature, nationally used data and exchange standards for information exchange are critical in order to give vendors more clarity and specificity.
And, AHA also calls for more stringent standards in ONC’s EHR certification program to ensure that EHRs are able to support interoperability in a real-world environment.
“Hospitals are required to purchase and use EHRs that have been certified by ONC as meeting all standards and supporting the sharing of health data. 2015 was the first year that all providers were required to use the most recent version of the certified EHR. However, these products often fail to operate in an interoperable way, despite certification,” the AHA report stated.
“Vendors must be held accountable for the design and marketing of these products in order to ensure hospitals are able to share data. Additionally, ONC should fix the certification program to ensure that EHRs are able to support interoperability in a real-world environment.”
Beginning in 2015, providers now face financial penalties for not meeting the information exchange and other requirements of the EHR Incentive Program.
“Hospitals are actively promoting the exchange of data, but additional technology and infrastructure solutions are needed to ensure that health IT products are able to readily and easily communicate with another to support the sharing of information critical to ensuring high-quality, efficient care delivery that is coordinated across the continuum” the AHA report concluded.