Progress Toward Interoperability Isn't Moving Quickly Enough

Ryan Black
OCTOBER 09, 2017
interoperability,health affairs,ehr,harvard business school,hca news
Despite being a constant concern in the healthcare management sphere, insufficient interoperability is still a major problem for hospitals.

A new study published in Health Affairs attempted to quantify just how deep the issue runs. The authors used data from thousands of hospitals from the Office of the National Coordinator for Health Information Technology and the IT Supplement of the annual American Hospital Association survey.

By the study’s metrics, less than a third (29.7%) of hospitals in 2015 had achieved a measure of interoperable proficiency, though that was a roughly 5% increase from the prior year.

In addition, the study found that only 43% of hospitals in 2015 reported having ready access to outside patient information when treating a person outside of their provider network. More than a third reported that they “rarely or never” used such information, and only 18.7% of hospitals reported “often” using data derived from external providers.

“They’re self-reporting this, which kind of makes it a little bit more worrying, because this is what hospitals say they can do,” author A Jay Holmgren, who studies health policy management at Harvard Business School, told Healthcare Analytics News.

“The takeaway is that, in 2009, we decided to spend $30 billion making different electronic healthcare systems and building all these electronic health records with the assumption that they would deliver upon this special goal of connectivity,” he added. “Not only are we still very far from that goal, we’re not progressing fast either.”

Although that $30 billion, provided by the HITECH Act, caused EHR adoption to skyrocket from less than 10% in 2008 to over 75% in 2014, the lack of widespread interoperability means most EHRs might as well still be in filing cabinets. Holmgren puts the blame for that in several corners: a lack of payer and patient demand, EHR vendor and hospital indifference (mostly as a means of maintaining customer exclusivity), technical complexity and frustrating system usability, and a lack of incentive.

The incentives created by HITECH make for uneven progress in the 4 different areas of interoperability, which include finding, sending, receiving, and integrating data. The new study shows improvements in the sending and receiving of data, which is how hospitals receive their funding in HITECH’s meaningful use measures, but stagnation in its actual integration and application.

“What they’re not good at is integrating that data,” Holmgren said, “Because it’s the hardest part, and they’re essentially on their own. They have to see value in bringing that data in and making it available for clinicians at the point of care, and if they don’t see that value, there’s not a business case for that.”

Holmgren does see potential for technology to drive improvement. He has some faith in the new HL7 FHIR standard, and he views blockchain as an “interesting” means for sharing patient data without the control of a third-party organization.

Hospital and EHR vendor consolidation might also improve interoperability, the author said. He indicated that his team would soon publish a study comparing EHR vendors on meaningful use characteristics, including interoperability. Some of them “clearly stand out,” he said.

“They’re a for-profit industry,” he said. “They’re in the game to make money. There’s nothing wrong with that, and I don’t think they’ve really stood in the way of interoperability, but I also don’t think they’ve really facilitated it, because their clients aren’t demanding it.”

The study, “Progress In Interoperability: Measuring US Hospitals’ Engagement In Sharing Patient Data,” was published earlier this month. Other co-authors included Vaishali Patel, an adviser in the Office of the National Coordinator for Health Information Technology at the Department of Health and Human Services, and Julia Adler-Milstein, an associate professor of medicine in the School of Medicine, University of California, San Francisco, who was a senior author on the work.

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