Health system interoperability shows meager advances
Tuesday, October 17, 2017
Given the tremendous amount of push toward interoperability in the healthcare setting — especially systems that are trying to communicate with others — there has been a lot of conversation about effort, but the results seem a bit harder to find.
Even as hard as interoperability efforts have been pressed, there's a little bit of unfortunate news here. A new study in Health Affairs suggests that less than 30 percent of health system EHRs are fully interoperable, and less than 20 percent actually use data transferred from another provider.
The study quantifies what many throughout the industry have highlighted as a priority for EHRs moving forward. According to the research brief, "achieving an interoperable healthcare system remains a top U.S. policy priority. Despite substantial efforts to encourage interoperability, the first set of national data in 2014 suggested that hospitals' engagement levels were low."
Additionally, with 2015 data now available, the researchers examined the first national trends in engagement in four domains of interoperability: finding, sending, receiving and integrating electronic patient information from outside providers.
"We found small gains, with 29.7 percent of hospitals engaging in all four domains in 2015 compared to 24.5 percent in 2014," the researchers wrote. "The two domains with the most progress were sending (with an increase of 8.1 percentage points) and receiving (an increase of 8.4 percentage points) information, while there was no change in integrating systems. Hospitals' use for patient care of data from outside providers was low, with only 18.7 percent of hospitals reporting that they 'often' used these data."
However, 37.2 percent of hospitals said they "rarely" or "never" use outside data for patient care. The study results reveal that hospitals' progress toward interoperability is slow and that progress is focused on moving information between hospitals, but not on ensuring usability of information in clinical decisions.
The research was collected from the American Hospital Association's annual survey, researchers at Harvard, the University of California San Francisco and a senior advisor at the Office of the National Coordinator for Health IT.
According to Fierce Healthcare, privately owned hospitals that are part of a larger system and had a comprehensive EHR were more likely to have information from outside sources available to them. Hospitals with a comprehensive EHR, as opposed to a basic system, were more likely to integrate patient information, which the authors highlight as a "critical for information usability."
That issue of usability is a priority for John Flemming, M.D., ONC's deputy assistant secretary for health technology reform. In a Health IT Buzz blog post, Flemming highlighted EHR dissatisfaction among physicians and said ONC is working with industry stakeholders as well as the Centers for Medicare and Medicaid Services and Congress to "determine the perfect recipe of usable health IT."
Additionally, the researchers noted that current policy efforts have "stimulated interoperability engagement only modestly," and new measures should hold EHR vendors accountable for information blocking. The researchers suggest that hospitals leaders "demand better interoperability" during discussions about bundled payments.
"What this means is there is potentially a significant amount of waste and inefficiency in hospitals," lead study author Jay Holmgren, a doctoral student at Harvard Business School, told Reuters.
Interoperability and usability were a tent pole topic that was discussed as part of the ONC's National Health IT Week event in early October.
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