Forging a path to greater data exchange, interoperability

Fueled by more than $26 billion in federal investments, EHR adoption has increased significantly among physicians and hospitals. But exchange of health information among clinicians, hospitals and other providers remains sparse despite its many benefits, according to a joint policy brief by Health Affairs and the Robert Wood Johnson Foundation, which examined this issue.

Health information exchange (HIE) is essential to improve the delivery of care as it promotes well-informed, coordinated and patient-centered care. Supported by health data from other care settings, clinicians can avoid duplicative tests, identify and address gaps in care and avoid medication and other errors. Most importantly, HIE is necessary for rapidly emerging delivery system and payment reforms, according to lead author Janet Marchibroda, director of the Health Innovation Initiative and executive director and CEO of the Council on Health and Innovation Bipartisan Policy Center, and colleagues.

However, only 14 percent of physicians surveyed in 2013 electronically shared data from outside their organizations, according to a study cited in the brief. A similar 2012 study indicates that only 51 percent of hospitals were sharing information with ambulatory care providers outside of their organizations.

The primary barriers to information sharing, according to research cited in the brief, include the cost association with exchange and the lack of standards adoption and interoperability of systems.

“There is little financial incentive to share information across settings to reduce costs or improve the quality of care. The significant increase in adoption of new models of delivery and payment across the U.S. as well as penalties for hospital readmissions implemented by CMS are expected to expand the business case for interoperability and information sharing,” according to the authors.

In the meantime, while interoperability requirements under HITECH have been limited, there is some movement to strengthen exchange.

For example, Office of the National Coordinator for Health IT certification requirements for 2014 are more robust, requiring the ability to exchange 23 data types, and it also specifies standards for the transport of data for the first time.

Also, Meaningful Use Stage 2 includes requirements for patients to be able to view, download or transmit data, as well as transmit them. “Stage 3 of Meaningful Use represents a significant opportunity to advance the interoperability of EHR technology and electronic information sharing among providers,” wrote Marchibroda et al.

Following a March 23 Department of Health and Human Services request for input on how to advance interoperability and HIE, stakeholders recommended a number of program and policy options, including: leveraging the federal contribution toward Medicaid at the 90/10 matching level to support HIE activities; adding new requirements within CMS's conditions of participation or coverage for a wide range of healthcare organizations; and including requirements for accountable care organizations under the Medicare Shared Savings Program and those participating in the Center for Medicare and Medicaid Innovation pilot programs.

But HHS has implemented few of these changes. “Moving forward with some of these suggestions, including CMS adding requirements to operating or pilot programs that will promote electronic exchange of information to support patient admissions, discharge, and transfers, as well as care coordination, will help create the business case for health information exchange,” wrote the authors.

Read the entire brief here.