Data exchange continues to face a range of limitations, including the persistent lack of EHR interoperability.


May 31—Electronic health record (EHR) adoption reached 84 percent of hospitals, and nearly as many were able to exchange key information with outside providers, according to new federal data.

The share of acute care hospitals adopting at least a basic EHR has grown sharply from 9.4 percent in 2008—the year before the federal EHR incentive program was enacted—to 83.8 percent in 2015, according to new data from the Office of the National Coordinator of Health Information Technology (ONC).

“That is a nine-fold increase since 2008. Amazing,” said Vindell Washington, MD, principal deputy national coordinator at ONC, said at a Washington, D.C., policy meeting announcing the results. “At ONC, we believe we're at a critical inflection point, one where technology, policy, and demand are poised to change the way we think about access and use of health information to improve care and advance science and public health.”

However the adoption of advanced EHRs—defined as those with comprehensive levels of functionality above basic electronic records with clinician notes—reached only 40 percent of hospitals in 2015.

Additionally, 96 percent of acute care hospitals “possessed” a certified EHR in 2015. However, “possessed” means only that the hospital has a legal agreement with an EHR vendor and is not equivalent to adoption.

Basic EHR adoption occurred across hospital types, with the lowest adoption rates—80 percent—seen among rural hospitals and critical access hospitals (CAHs). Basic EHR adoption has increased from 36 percent of rural hospitals and 35 percent of CAHs in 2012.

The broad geographic nature of the adoption was reflected by ONC data showing basic EHR adoption occurred among more than 65 percent of hospitals in each state by 2015.

Information Exchange Progress

The share of acute care hospitals electronically exchanging laboratory results, radiology reports, clinical care summaries, or medication lists with outside ambulatory care providers or hospitals reached 82 percent in 2015, up from 76 percent in 2014, according to another ONC report.

However, only 46 percent of all acute care hospitals had providers who were able to electronically access necessary clinical information from outside providers or other sources in 2015. That was a slight improvement from 41 percent in 2014.

Less than one-fifth of hospitals reported their providers often used patient health information received electronically from outside their hospital system when treating their patients, while 36 percent said their providers rarely or never used such data in treating patients.

The most common reason for not using patient health information received electronically from outside providers was that the information was not available to view within the EHR. Similarly, the inability of exchange partners to receive data was the most frequently identified barrier to interoperability

Washington described the flow of health information as “critical to many of our national priorities,” like precision medicine or the National Cancer Moonshot Initiative led by Vice President Joe Biden.

The data release came on the same day the Centers for Medicare & Medicaid Services issued a correctionto the final rule implementing Stage 3 of meaningful use. The change to Measure 2—which requires hospitals to add to a patient’s record an electronic summary of care document for more than 40 percent of transitions and referrals received and encounters with new patients—deletes the requirement that the source of the summary of care document be from outside the provider’s EHR.

Interoperability Push

The latest data on information exchange among providers came amid the Obama administration’s ongoing push to lower the barriers to interoperability and data exchange. One part of that push has been an effort to get vendors and providers to pledge not to block the flow of patient data.

Although the vendors signing the pledge provide 90 percent of the EHRs in U.S. hospitals, providers continued to raise concerns that vendors are blocking data.

“In Oklahoma, we see little provider data blocking and the reason for that is because the value-based providers have taken root, they are dependent on how well they take care of patients, and as a physician, I take the oath I will do no harm and share data where it needs to go—whether the patient leaves my practice or not, I'm obligated to help the next doctor in line take care of that patient,” David C. Kendrick, MD, a board member of the Strategic Health Information Exchange Collaborative said at the event.

In contrast, many providers must pay vendors to join a local health information exchange network.

“That will not get interoperability done in this country, and we need to protect the role of governance in the exchange of this data to cover that,” Kendrick said.

The lengthy ongoing process to develop common interoperability standards also drew criticism from providers.

“What we are trying to do isn't that hard—we're trying to define a set of data that we can move between information systems, and in health systems across the country and banks, we do it all the time,” Marc Probst, CIO, Intermountain Healthcare, said at the meeting.

Meanwhile, David McCallie, MD, a senior vice president at Cerner Corp., warned that the current definition of interoperability is inadequate and will not provide clinicians with “actionable” data.

“We're going to go from having little interoperability to having lots of data flowing and then discover that is not good enough,” McCallie said.

The solution to the lack of actionable data may be the ability to plug an app, like one with a population health manager setting, into a remote system to provide the needed data, according to McCallie.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C. office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Wednesday, June 01, 2016