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A fundamental promise of EHRs has always been interoperability. The idea being that patients and their doctors can have the same reference points as they discuss healthcare strategies in order to reduce care gaps.
That might include emergency situations, physicians on care teams exchanging health data amongst themselves, even specialists in other networks or geographical regions, and small medical groups.
Unfortunately, very few practices — 14 percent, according to a 2013 Health Affairs study just released — are sharing patient information outside of their own group. Health information exchange within physician groups is also surprisingly low at about 33 percent. And sharing data with those in unaffiliated hospitals is barely 5 percent. This despite $26 billion allocated for the adoption of interoperable EHRs by the HITECH Act and $546 million allocated directly to states for the same.
“HHS sought input and received suggestions in 2013, but little has been implemented,” the Health Affairs report explained.
Perhaps an even more relevant study would focus on whether the low HIE numbers are due not so much to reluctance on the part of physicians practices, who often get the blame, but rather on EHR providers and the lack of standards needed to implement interoperability.
[See also: 6 questions with an HIE pioneer]
The truth is, despite the ongoing focus of the news media on EHRs, challenges remain and the uptake has not been startling, although the benefits for those that have taken the leap appear to be real.
In California, for instance, Anthem and BlueShield together have ponied up $80 million to create Cal Index, offering longitudinal patient records, a provider portal with alerts and reminders, and plans to include 30 provider systems, according to HIT Trends.
While payers and their customers will obviously benefit from this alliance, from a financial point of view the physician has to evaluate the investment and expense.
What will it cost in terms of technology to ensure interoperability, privacy and IT maintenance?
There has been some progress on implementation of HIEs but physicians practices, perhaps wisely, are simply waiting for the technology to be perfected.
The Office of the National Coordinator for Health Information (ONC) reports growth in exchange capability and activity, notwithstanding “substantial room for improvement.”
Vaishali Patel, a senior advisor with ONC’s office of policy, evaluation and planning, noted that the ONC survey, conducted by the CDC’s National Center for Health Statistics, shows the complexity of data exchange is a common problem among those physicians attempting to exchange health data. Vaishali said ONC is looking to two drivers to increase exchange activity in the future: implementation of Stage 2 meaningful use and changes in care delivery between providers in order to improve health outcomes.
While ONC offers a bar graph that indicates the majority of physicians who utilize HIE report benefits, increasing practice efficiency by 80 percent, and quality of care by 89 percent, ONC also states that 42 percent of those physicians using HIE have seen an increase in the practices’ vendor costs and 64 percent said it required multiple systems or portals.
No matter the type of health data exchanged in a physician's practice, be it lab results, imaging reports, problem lists, medication lists or medical allergy lists, the amount of data exchanged in all categories remains in the mid 30 percent range.
There are also a number of somewhat surprising stats coming out of ONC. Less than half of hospitals send electronic notifications to the primary care provider upon emergency room entry of their patient. For those PCPs outside of the ER system, the percent that are “routinely” notified falls to approximately 25.
In some cases patients are also short-changed on receiving their health data electronically. Eighteen percent had to ask to have their medical history resent from another provider, and in some cases the patient had to hand in a paper copy of an exam or test results.
Despite the apparent lack of enthusiasm for HIE as it is now implemented, a rapid transition is on the horizon. The catalyst for this growth can be found in the phenomenal expansion in e-visits.
Deloitte’s report on “The 21st Century Housecall,” in fact, predicts a 400 percent increase since 2012 globally, and with CMS reimbursing for electronic chronic care on the home front, 75 million e-visits are expected in 2014 — that’s 25 percent of the addressable market with potential industry-wide savings of $5 billion.
With numbers like that, e-visits will be the tsunami that sweeps away all remaining impediments to implementing health information exchange and HIEs will become a must-have for every hospital and physicians’ practice.
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