The Office for the National Coordinator for Health IT (ONC) released a data brief providing recent estimates on the state of interoperable exchange activity among acute care hospitals and the data indicates that some progress has been made with regard to data sharing, while barriers to actually using and integrating data remain.
The data brief is based on data from the American Hospital Association’s (AHA) Annual Survey Information Technology Supplement.
Overall, the rate of hospitals electronically sending, receiving and finding key clinical information to and from providers or sources outside their hospital system notably 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.
However, 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. And, that percentage actually dropped from 40 percent in 2014. About 4 in 10 hospitals had the capability to integrate data into their EHRs without manual entry.
Twenty-six percent of hospitals reported conducting all four domains (finding, sending, receiving and using or integrating data), an increase from 23 percent in 2014. “Findings from both 2014 and 2015 demonstrate the benefits of engaging in all four core domains of interoperability. Hospitals that engaged in all four core interoperability domains had necessary patient information electronically available from outside sources and providers, about twice the national average,” the ONC data brief stated.
According to the ONC data brief, interoperability of health information is a national priority. 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 electronic health record (EHR) technology nationwide by December 31, 2018.
The Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap (Roadmap) described the policy and technical actions needed to enable nationwide interoperability. It also identified four key domains of interoperability as electronically sending, receiving, finding, and integrating or using key clinical information, according to the data brief.
The ONC data brief also reports that the percentage 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 has doubled since 2008, when 41 percent of all hospitals electronically exchanged health information with outside providers. In 2015, 83 percent of hospitals reported electronically exchanging these key types of information, and that percentage stood at 50 percent in 2011.
A little less than half of hospitals (46 percent) reported having necessary patient information electronically available from providers or sources outside their systems at the point of care. In both 2014 and 2015, hospitals that conducted all four domains related to interoperable exchange were about twice as likely to have necessary clinical information electronically available from outside providers or sources at the point of care as the national average.
Drilling down into the actual use or integration of patient health information that's electronically exchanged, about one-third of hospitals (36 percent) reported that their providers "rarely" or "never" use patient health information received electronically from outside their hospital system when treating their patients. Less than one-fifth (18 percent) cited that their providers “often” use patient health information received electronically from outside their hospital system when treating their patients. And, about one-third (35 percent) said that their providers “sometimes” used patient information received from outside sources.
The most common reason for not using such information related to the inability to access the information from within their EHR, whether that was due to clinical workflow or inability to integrate data from outside sources into the EHR. Of the hospitals who reported that providers "rarely" or "never" used patient health information received electronically from outside providers, 53 reported information was not available to view in the EHR as part of clinicians’ workflow, and another 45 percent cited difficulty in integrating information into EHRs.
In addition, 40 percent of hospitals who reported "rarely" or "never" using health information received electronically from providers outside their health systems cited that the information was not always available. And, 29 percent reported that information was not presented in a useful format, while 11 percent of hospitals reported that they did not trust the accuracy of information received from outside sources.
The ONC data brief also used the AHA survey information to look at barriers to the exchange and use of health information. The most frequently identified barrier, according to the AHA survey data, related to the capabilities of exchange partners’ EHR systems. Most of the reasons given were technical. For instance, more than half of hospitals reported that their exchange partners’ EHR system lacks capability to receive data as the key issue when trying to electronically send, receive or find health information to/from other care settings or organizations. And, 53 percent cited that their exchange partner lacked an EHR system or other system to receive data.
About half of hospitals in 2015 reported experiencing greater challenges exchanging across different vendor platforms (46 percent) and difficulty finding providers’ address (49 percent).
Other technical interoperability barriers that were identified by hospital respondents included difficulty matching or identifying patients (33 percent); lack of capability to electronically receive data from outside sources (14 percent) and lack of capability to electronically send data to outside sources (8 percent).
And, hospital respondents also identified a number of operational barriers, such as cumbersome workflow to send from the EHR system (32 percent) and that recipients of care summaries report that the information is not useful (31 percent).
Financial barriers also were cited. A quarter of hospital respondents cited that additional costs to exchange with outside providers or settings was a barrier to health data exchange.
Between 2014 and 2015, the rate of hospitals reporting difficulty with patient matching significantly increased by nine percentage points, higher than any other barrier.
“Continued increases in the interoperable exchange and use of health information from outside sources along with the availability of information are important to the success of care transformation efforts nationwide, which will likely expand with the implementation of the MACRA. However, there is still significant progress to be made to improve the use of exchanged information and to address barriers to interoperability,” ONC stated in the data brief.
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