“Care continuum” has a nice ring to it. But the term doesn’t mean much unless acute-care and non-acute-care providers coordinate their patient-care activities. And that’s impossible without communication. That’s why many believe that interoperability – the ability of providers to exchange electronic health information with other systems and process the information without special effort by the user – is so important.
The federal government encourages interoperability by rewarding providers that install electronic health records (EHR) systems, and penalizing those that don’t. But many non-federal initiatives are at play as well.
Representatives from 18 such initiatives describe their efforts to achieve or facilitate EHR interoperability in a recent report from the U.S. Government Accounting Office. Their efforts include creating guidance related to health data standards, encouraging the adoption of certain health data standards or policies that facilitate interoperability, and operating networks that connect EHR systems.
Five challenges
Most of these initiatives remain “works in progress,” says the GAO in its September 2015 report, “Electronic Health Records: Nonfederal Efforts to Help Achieve Health Information Interoperability.”
Stakeholders and representatives from the initiatives described five key challenges to achieving EHR interoperability.
- Insufficiencies in standards. Some standards allow EHR systems to use different formats and terminology when exchanging data. This variability prevents the receiving system from processing the information and properly integrating it into the patient record.
- Variation in state privacy rules. Exchanging health information with providers in other states can be difficult due to variations in privacy rules from state to state, especially variation in laws pertaining to patient consent for sharing health information.
- Accurately matching patients’ health records. Many EHR systems use demographic information, such as a patient’s name and date of birth, to match health records for a given patient held by different providers. But demographic variables do not always yield accurate results because, for example, there could be more than one patient with the same information. In addition, providers may not collect and use the same demographic variables for matching.
- Cost. The costs associated with achieving interoperability can be prohibitive for providers, in part because of the high cost of EHR customization and legal fees.
- Need for governance and trust among entities. These governance practices can include organizational policies related to privacy, information security, data use, technical standards, and other issues that affect the exchange of information across organizational boundaries.
In addition to these five challenges, GAO identified two other issues that need to be addressed if nationwide interoperability is to move forward:
- Providers need to see a value in interoperability. Policies that tie payment to quality of care rather than number of services provided may incentivize sharing of information across providers.
- The Centers for Medicare & Medicaid Services might need to change its EHR incentive programs. Currently, efforts to meet the CMS programs’ requirements divert resources and attention from other efforts to enable interoperability.
To read the GAO report, go to http://gao.gov/assets/680/672952.pdf
Why interoperability?
The U.S. Department of Health and Human Services and others view EHR system interoperability as a necessary step toward transforming health care into a system that can achieve goals of improved quality, efficiency and patient safety. For example, use of interoperable EHR systems could better enable healthcare providers to:
- View results from diagnostic procedures conducted by other providers to avoid duplication.
- Evaluate test results and treatment outcomes over time regardless of where the care was provided to better understand a patient’s medical history.
- Share a basic set of patient information with specialists during referrals and receive updated information after the patient’s visit with the specialist.
- View complete medication lists to reduce the chance of duplicate therapy, drug interactions, medication abuse, and other adverse drug events.
- Identify important information, such as allergies or preexisting conditions, for unfamiliar patients during emergency treatment.
Source: “Electronic Health Records: Nonfederal Efforts to Help Achieve Health Information Interoperability,” U.S. Government Accounting Office, September 2015