Next week a federal task force will recommend that the Office of the National Coordinator should switch gears with meaningful use to focus solely on interoperability through use of the FHIR (Fast Healthcare Interoperability Resources) standard under development by HL7 and the use of public application programming interfaces (APIs). Serving as a reminder of why a new approach might be necessary was the eHealth Initiative’s 11th annual data exchange survey, released Oct. 8, which found health information exchange organizations still struggling with interoperability issues.
The survey of 135 health information organizations found that, as in previous years, challenges to interoperability include financial costs of building interfaces, getting consistent and timely response from EHR vendor interface developers, and technical difficulty of building interfaces.
During a webinar panel of HIE executives responding to the survey, Kevin Stambaugh, director of Physician e-Services of Intermountain Healthcare in Utah, talked about the difficulty in working with providers and vendors on exchanging CCDs (Continuity of Care Documents). “The vendors are not mature in this space,” he said. “Only last year were we able to get the first CCD out of an EMR into our data repository and it took two years. That was their first experience doing it.”
“Some EHR vendors have gotten smarter and assigned specific resource to work with us every time. That has made things easier,” Stambaugh said. Other vendors, he added, might have a new person deal with Intermountain each time and “it is like we are starting from scratch every time.” Other vendors have task list queues for integrations that might be five to six months out. “We have no ability to impact their resources, and often the practices don’t feel empowered to pressure them to move quickly,” he said.
Three-quarters of respondents (101) incorporate secure messaging into their data exchange models. Eighty-one respondents report their users access data through secure messaging. Seventy-eight respondents offer a Direct address directory. More respondents indicated that they are using Direct for all given use cases this year than last year.
During the panel, Christina Galanis, executive director of Southern Tier HealthLink, a regional health information organization in Binghamton, N.Y., expressed concern about the increasing use of Direct. It is the easy button for practices and vendors who don’t want to get creative and figure out how to use the HIE more fully, she said. “It is great for one-to-one referral,” she said, but she senses that providers that would have found a way to do full-blown exchange are just doing Direct instead in order to check off a box for meaningful use. “Then it is harder to get them back to the bigger table of contributing data. Galanis said if HIEs are just the post office passing messages through with no access to the data, how will they make it available in life-saving emergencies or offer sophisticated analytics services?
Eighty-five respondents have implemented notification/alerting services to support transitions of care. More than 100 offered care summary exchange as a service, and 74 respondents offer reporting to immunization registries. Sixty-four said they support an ACO, while 52 support a patient-centered medical home. Yet most still have a long way to go to achieve sustainability. Only 41 organizations report that dues or fees are their greatest revenue source.
When a webinar attendee asked about the potential of FHIR and public APIs, some panelists expressed concern that introducing something new could further delay interoperability because the industry hasn’t caught up with the requirements around exchanging documents yet.
“It might help if the government mandated standards, but they have to be careful because we have seen problems in the past with the government imposing standards that weren’t fully baked,” said David Grinberg, deputy executive director, Pennsylvania eHealth Partnership Authority.