Nearly all hospitals have the infrastructure to exchange data, yet just 25 percent of hospitals nationwide are finding, sending, receiving and using data electronically, according to a report from the American Hospital Association (AHA) and the Office of the National Coordinator for Health IT (ONC).
At a Health IT Policy Committee meeting on Aug. 11, Vaishali Patel, an ONC senior advisor, presented data from a 2014 AHA survey of healthcare providers across the U.S. Health information exchange (HIE) activity among hospitals is increasing, however further progress is still needed, the report found. Specifically, most hospitals have certified electronic health record (EHR) technology and are exchanging key clinical information: 75.5 percent of hospitals said they had a basic electronic health record system, up from 59.4 percent in 2013; and nearly 97 percent of hospitals with basic EHR systems said they had certified EHR technology, up from 94 percent in 2013.
Also, hospitals’ rates of conducting different types of interoperable exchange vary. Seventy-eight percent of respondents said they are able to send patient summary care records; 56 percent can receive them; 40 percent can use them; 48 percent can find health information from outside sources; but just 23 percent can do all four of these interoperable exchange activities.
“One important thing that the report does is demonstrate that achieving interoperability requires action from multiple sectors—public and private included,” says Erica Galvez, interoperability portfolio manager, ONC. Galvez, who spoke to HCI about the report’s findings and implications, adds, “While government clearly has a role so do providers and technology developers. Alignment across all those activities is critical, otherwise the pieces don’t line up.”
Not surprisingly, hospitals conducting more interoperable exchange have higher rates of information electronically available at the point of care from outside sources/settings, per the chart below from ONC/AHA.
What’s more, limited capability of exchange partners to receive information electronically is a top barrier, provider respondents said. Technical barriers—more so than operational or financial barriers—prove to be the biggest interoperability roadblocks for providers, according to the report.
In regards to these findings, Galvez says that based on what ONC hears from its engagement with stakeholders, many times the lack of data-trading partners surfaces from the fact that hospital partners include skilled-nursing facilities (SNFs) and home health facilities that are part of the long-term post-acute care and behavioral health categories. “Those groups in many cases were not eligible for financial incentives to adopt health IT, so there will be a slower adoption curve in these communities without the financial offset,” she says. “If we can find other ways to help those folks with lighter-weight IT options, that could help. EHRs are a heavy stack.”
What’s more, exchange with outside ambulatory care providers and hospitals has been increasing significantly over time, Patel reported. About 75 percent of respondents said they exchange with outside ambulatory providers, up from 62 percent in 2013. These percentages are of non-federal acute care hospitals that electronically exchanged laboratory results, radiology reports, clinical care summaries, or medication lists with ambulatory care providers or hospitals outside their organization, Patel noted.
The report additionally found that rates of summary of care record exchange between hospitals and providers along the care continuum also varies— about 75 percent of hospitals are sending summary of care records electronically and about half receive summary of care records electronically. However, fewer than one in 10 hospitals use only electronic means of sending or receiving summary of care records with outside sources, while only 4 in 10 hospitals reported they can integrate information from patient summary of care records into their EHRs.
Galvez says some of these low numbers disappoint her, as it challenges ONC’s expectations for what was expected when these products were rolled out for meaningful use. “In an ideal world they would produce beautiful clinical document architectures (CDAs). The reality is that first, those technical standards and implementation guides used to develop consolidated CDAs (C-CDAs) need to be constrained, and there is general agreement about that,” Galvez says. “Also, providers need filtering tools, a way for their user interface to very rapidly help them pinpoint information in real time from those care summaries. That does not happen across the board today. Technology developers need to put sophisticated filtering tools in the hands of their customers so they can very quickly identifiable information without having to go through volumes of C-CDA material,” she says.
Further, Patel gave an update to ONC’s draft interoperability measurement framework, providing near- and long-term goals for the industry. The scope of near-term (2015-2017) interoperability measurement includes:
- Movement of health information across the care continuum and individuals
- Barriers impeding interoperability
- Increasing availability of information and subsequent usage
The scope of the long-term measurement (beyond 2017) expands:
- Settings beyond healthcare
- Impacts on key processes and outcomes sensitive to interoperability
Patel noted that next steps next steps will include reporting on baseline levels of interoperability and exchange for the near-term and sharing updates to the measurement framework as the interoperability roadmap gets published later this year.
“I think it is important to recognize where we have come over the last many years,” says Galvez. “If you look where we were pre-HITECH and where we are today, we have made significant progress. We should feel good about that, but it’s not enough. There is more work to be done, particularly in making sure data is computable and that there are enough trading partners. We can both celebrate progress and recognize that there is work to be done,” Galvez says.