The State of Minnesota Department of Health’s Office of Information Technology provides a great public service by regularly surveying all types of providers and publishing analyses of the results. And while Minnesota is a success story when it comes to EHR adoption, e-prescribing, clinical decision support and patient portal adoption, the 2016 survey of ambulatory clinics does raise a few red flags. For one, the percentage of clinics that said they have exchanged data with unaffiliated hospitals or clinics actually fell 4 percent, from 73 percent in 2015 to 69 percent in 2016. Twenty-seven percent said the value of the investment in secure HIE was unclear to them.
I have written before about the value of Minnesota’s e-health snapshots of providers, labs and hospitals. The current summary includes information collected in the 2016 Minnesota Health Information Technology Ambulatory Clinic Survey. The 1,285 ambulatory clinics that completed the survey provide information on EHR adoption and use, health information exchange and meaningful use. Looking at most of these measures, ambulatory clinics in Minnesota have had great success in adopting EHRs and using them to support patient care. Ninety-nine percent of clinics are using CPOE for most orders; 90 percent are routinely using medication guides/alerts; and 88 percent are e-prescribing. Ninety-five percent agreed that the EHR has enhanced patient care in their clinic, and 96 percent said EHRs have alerted providers to potential medication errors.
But the findings about HIE and others about interoperability may raise red flags. Although most providers identified a strong need to share data with providers outside their health system, that type of exchange is proving difficult. While 92 percent say there is a need to share with other ambulatory providers outside their system, only 68 percent are doing so. And 89 percent said they needed to share with hospitals outside their health system, only 58 percent reported doing so. Only 52 percent exchange with the Minnesota Department of Health. While 71 percent said they needed to share with nursing homes, only 30 percent said they do so. Sixty-four percent said they need to exchange with behavioral providers, and only 30 percent said they do so now.
Less than half of clinics receive notifications from hospitals when their patient is admitted, discharged or transferred, and almost all of those (40 percent) are from hospitals from within the same health system.
Regarding top challenges to HIE, 50 percent said managing consent to share information and the fact that partners are not able to electronically exchange health information were top issues.
Another interesting point regards the interoperability of data: Most clinics do not incorporate electronic information from other providers into their EHRs as standardized data. Only 31 percent of clinics integrated data in standardized format for immunization, 25 percent for medication history, 19 percent for lab results, and just 12 percent for summary-of-care records. The vast majority said they fax/scan/PDF the data to and from outside sources.
This issue of data exchange and interoperability feeds into questions about EHR market share. Clinics that use the same EHR have less difficulty exchanging clinical data, and in Minnesota 51 percent of clinics use Epic. Those 641 clinics dwarf the second-highest number, which is eClinicalWorks at 112 or 9 percent. No other provider has more than 5 percent. (Fifty-eight percent of primary care doctors use Epic.) But this raises questions about whether we are headed toward an eventual monopoly or a duopoly in the EHR market and whether that would have other deleterious effects on the improvement of clinical information systems. What would it mean if Epic had an 80 percent market share? Ninety percent?
The report’s conclusion notes that “healthcare providers are increasingly embracing EHRs and related technologies to improve population health, but more work is needed to achieve interoperability. Results from this study demonstrate that clinics still face gaps between their need to share health information and their ability to do so electronically, and even more problems achieving interoperability.”