Hospital interoperability push moving from adoption to 'routine' use, ONC says

The proportion of hospitals meeting the Office of the National Coordinator for Health IT’s (ONC’s) bar for interoperability rose substantially from 2018 to 2023, though a focus on day-to-date data exchange will be necessary to fill some remaining gaps.

According to a recent data brief from ONC, 7 in 10 nonfederal acute care hospitals reported either “routinely” or “sometimes” engaging in all four measured domains of electronic health information interoperability: sending data (92%), receiving data (87%), querying data from outside their organization (84%) and integrating outside data into their records without manual entry (78%).

The 70% top line is an improvement from the 23% of 2014 and the 46% of 2018. Interoperability remained flat at 70% from 2022 to 2023, though the ONC noted that its surveys for the two years were fielded nearly back-to-back to catch up following pandemic polling delays.

However, the ONC found a broad gulf in interoperability frequency among hospitals of different characteristics.

Specifically, there were statistically significant rates of “routine” interoperability, between hospitals that were rural and urban (36% vs. 47%); independent or system affiliated (22% vs. 53%); Critical Access Hospitals and non-Critical Access Hospitals (37% and 45%); and small, medium and large hospitals (38% vs. 46% vs. 53%).

There were similar significant differences when comparing hospital types reporting that they were “sometimes” interoperable, with the exception of independent and system-affiliated facilities.

The ONC’s post largely celebrated the gains but noted that the findings underscore where the office will need to "raise the bar" to focus on "often or routine interoperable exchange.”

Line Graph Showing the Percent of U.S. Non-Federal Acute Care Hospitals Engaged in Interoperable Exchange of Electronic Health Information: 2018-2023.
Percent of U.S. non-federal acute care hospitals engaged in interoperable exchange of electronic health information: 2018-2023. (The Office of the National Coordinator for Health IT)

Here, the ONC pointed to the rate at which hospitals said their clinicians use data from outside providers at the point of care—42% overall. The ONC noted that this measure was higher among the 43% of hospitals that reported routine interoperability (70% point-of-care data outside data use) than the 27% that said they were sometimes interoperable (26%) and the 30% that said they were not (18%).

Additionally, the office noted that outside data exchange is, so far, more common between different hospitals and ambulatory care providers. External data sharing was less frequent with long-term post-acute care providers and behavioral health providers.

While this finding broadly suggests “an ongoing need for comprehensive engagement in interoperability across the healthcare continuum,” the ONC again pointed to a pattern of hospitals reporting routine interoperability much more frequently engaged with all types of external providers.

“The Health Information Technology Advisory Committee (HITAC) emphasizes the importance of addressing these interoperability gaps across the care continuum to advance the use of technologies that bolster interoperability, which is crucial for realizing the full potential of health IT tools in transforming the entire healthcare sector,” ONC wrote while pointing to ongoing efforts such as the Trusted Exchange Framework and Common Agreement (TEFCA) and the Behavioral Health IT Initiative.