A recent data brief from the Office for the National Coordinator for Health IT (ONC), based on information from the 2015 edition of the American Hospital Association’s (AHA) annual survey IT supplement, reveals that year over year, not that much has changed regarding hospitals’ ability to exchange patient medical records with all other healthcare providers.
For some perspective, let’s go back to last August when AHA and ONC produced the same annual survey, this time based on 2014 hospital data. That report found that while nearly all hospitals said they have the infrastructure to exchange data, just one-quarter of them nationwide are finding, sending, receiving and using data electronically.
When I saw these numbers last summer, my main takeaway was that when the same brief came out in 2016, we would be seeing a stark improvement in hospitals’ ability to perform the many facets of exchanging data electronically. But as Healthcare Informatics Assistant Editor Heather Landi reported last week, that hasn’t really been the case.
Landi reported that only 38 percent of hospitals reported using or integrating patient summary care of records that were either electronically sent from sources outside their health system, or that the organization electronically found. That percentage actually dropped from 40 percent in 2014. About four in 10 hospitals had the capability to integrate data into their EHRs without manual entry. Meanwhile, 26 percent of hospitals reported conducting all four above-mentioned interoperability domains (finding, sending, receiving and using or integrating data), an increase of just 3 percent from 2014.
Now, the data isn’t all bad. Overall, the rate of hospitals electronically sending, receiving and finding key clinical information to and from providers or sources outside their hospital system increased between 2014 and 2015. In 2015, 85 percent of hospitals reported sending data outside their organizations, up from 78 percent in 2014; 65 percent reported receiving data from outside their organizations, up from 56 percent in 2014 and 52 percent cited finding key clinical information electronically versus 48 percent in 2014. So, there were increases across three out of the four domains comprising interoperability.
However, the key statistic to me is that still, only one-quarter of U.S. hospitals surveyed are performing all aspects of patient data exchange. This takes me back to something that National Coordinator for Health IT Karen DeSalvo, M.D., said last December at a Bipartisan Policy Center event: “We have built—through the hard work of the private sector and states—an infrastructure where every state has an information highway. In some communities, it’s already connected across state lines. Our goal is to connect that highway, including the health information exchanges [and] the private sector exchanges, in the entire country within a year.”
Complete health information exchange (HIE) connectivity by the end of 2016? There is just no way that’s possible, and these data briefs from the last two years all but confirm that. After DeSalvo made those comments late last year, I wrote a blog about how her goal will ultimately fall way short. I further noted that ONC itself even wasn’t this ambitious when, last October, it released the final version of its Interoperability Roadmap.
After last year’s data sharing results came through, I spoke to then-interoperability program manager at ONC (now with Dr. Farzad Mostashari’s healthcare technology company Aledade), who said that the low numbers disappointed her, as it challenged ONC’s expectations for what was expected when electronic health record (EHR) products were rolled out for meaningful use. Glavez importantly noted last year that the lack of data-trading partners surfaces from the fact that hospital partners include skilled-nursing facilities (SNFs) and home health facilities— groups that in many cases were not eligible for financial incentives to adopt health IT, resulting in slower adoption curves. She concluded, “Providers need filtering tools, a way for their user interface to very rapidly help them pinpoint information in real time from those [patient] care summaries. That does not happen across the board today.”
What’s more, a second ONC/AHA data brief released last week showed that in 2015, certified EHR adoption among the nation’s hospitals remains high, with nearly all reported hospitals (96 percent) possessing certified EHR technology last year. This rate is similar to 2014, suggesting that adoption of certified EHR systems may be plateauing. The objective to get all hospitals certified EHR software is all but complete. But, at what point will we see the next step be taken in which hospitals are actually meaningfully using and exchanging the EHR data to improve care?
That is the burning question that no one really knows the answer to. In this year’s data brief, only 18 percent of those surveyed indicated their hospital clinicians often use patient information received electronically from outside providers or other sources, while another 35 percent use such information “sometimes.” Another 20 percent use it “rarely”; 16 percent reported using it “never.”
This brings me to a front page New York Times story from June 5 that references an industry-by-industry analysis from the McKinsey Global Institute, the research arm of the consulting firm McKinsey & Company. The report found that only 18 percent of the American economy is living up to its “digital potential.” Sure enough, per the NYT story, “some industries, like technology, media and financial services, were well along, while others, like healthcare and hospitality, trailed.”
The reasons for hospitals not being able to send and receive data electronically vary. The most frequently identified barrier, according to the AHA survey data, related to the capabilities of exchange partners’ EHR systems. More than half of hospitals reported that their exchange partners’ EHR system lacks capability to receive data as the key issue; 53 percent cited that their exchange partner lacked an EHR system or other system to receive data. These top barriers were the same challenges reported last year.
Undoubtedly, healthcare interoperability is a national priority. As Landi wrote in her story on the ONC/AHA data brief, “In the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Congress declared it a national objective to achieve widespread exchange of health information through interoperable certified EHR technology nationwide by December 31, 2018.”
Certainly, 2018 is a far more appropriate goal than DeSalvo’s bold HIE connectivity claim last December. To me, though, actions always speak louder than words. And in this case, the actions—or lack thereof—we are seeing from hospitals when it comes to data exchange are nothing to write home about. Many health IT leaders have long attested that “true” interoperability will be a several-year process, but for even that to become a reality, vendors and clinical end users collectively need to step their games up.
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