Healthcare providers and technology vendors have made steady progress in some areas related to interoperability and leaps forward in others, according to a new report.
Two-thirds of providers (67%) report they often or nearly always had access to needed patient records in 2020, a report by the College of Healthcare Information Management Executives (CHIME) and KLAS Research found. Compare that to four years ago when providers said they could reasonably access information from exchange partners on a different electronic health record only 28% of the time.
Providers now report they've seen improvements in EHR functionality and usability for tasks like locating and viewing records. The biggest gains seen were between partnering organizations using different medical records systems, according to the report.
Many providers also are increasingly optimistic that these changes will allow record exchange to have a greater impact on patient care in the future, according to the report, which was based on data from a 2020 interoperability survey, with comparisons to a prior large-scale interoperability study in 2017.
The CHIME-KLAS white paper examined trends in interoperability overall, finding EHR connections with outside systems have made notable improvements, ambulatory clinics and smaller hospitals are connecting more than ever before, and national networks have reached a tipping point.
Recent federal efforts to promote interoperability have been a lever for removing barriers and facilitating uptake. In 2018, the Centers for Medicare & Medicaid Services (CMS) renamed its EHR Incentive Programs to Promoting Interoperability and the 21st Century Cures Act includes interoperability and patient data access provisions.
"For digital health to reach its full potential, we need to be able to safely and securely exchange information across the healthcare ecosystem,” said CHIME President and CEO Russell Branzell in a statement. “Interoperability is the linchpin. With the Cures Act and other federal initiatives promoting data sharing, we should see even more gains that ultimately will improve patient care. As is evident in the survey results, great strides have been made resulting in remarkable improvements. This required hard work for all parties involved and they should be congratulated on their collective efforts.”
“While there’s always room for improvement, we were glad to see provider organizations report progress in data sharing across disparate EMRs. Now we must continue to expand that interoperability beyond the EHR and ensure we truly impact the care of patients," said Adam Gale, president of KLAS.
However, the industry still hasn't quite reached the finish line when it comes to data sharing. Only 15% of providers report that data exchange has impacted patient care, but that's up from 6% in 2017.
Here are six trends that paint a clearer picture of the current state of interoperability in healthcare, both the good news and the bad news:
EHR connectivity has increased: Over the last four years, almost all EHR companies have improved their connections to outside EHR solutions, the report found. The biggest gains have come because of vendor proactivity; vendors who take an active role in helping push provider organizations to success have seen the most progress. In some instances, lack of technical expertise and regulatory challenges have limited connections to outside EHR vendors. In other instances, technology companies have made a strategic decision to focus on other aspects of interoperability, such as FHIR (Fast Healthcare Interoperability Resources), in preparation for expected government requirements.
Vendors need to do more: About half of provider organizations say they are not getting the vendor support they need to advance interoperable healthcare. By far, the most mentioned barrier to success was cost. Buying the latest features and functionality, paying for new interfaces and connections, and the cost to keep up system customization are frequent complaints, the report found. When cost is not prohibitive, it is a lack of deep understanding of provider workflows and organizational needs and a lack of technical readiness that prevent vendors from fully supporting customers.
National data sharing networks prove their value: The use of national networks such as the CommonWell-Carequality connection has continued to grow since 2017, when this data-sharing method was barely on organizations’ radar, the report said. More than one-third of respondents (36%) consider national networks the most valuable method for accessing patient data, while 39% chose public health information exchanges. Organizations leveraging these networks are significantly more likely to report achieving what KLAS and CHIME described as "deep interoperability."
Ambulatory clinics and smaller hospitals making gains: Organizations that previously were under little pressure to exchange with affiliates are now making strides to deepen connections and integration with affiliate hospitals. The most notable increases are in ambulatory clinics and in acute care hospitals with less than 200 beds. The increased ambulatory connections are mostly with affiliate hospitals using larger acute care EMR vendors.
FHIR adoption is taking hold: The adoption of FHIR application programming interfaces (APIs) lags behind the adoption of proprietary APIs. Larger health systems are starting to leverage FHIR APIs for patient-record exchange, clinician-enabling tools and patient-facing tools. These organizations tend to be larger, more advanced health systems with around 2,000 beds.
But, many IT leaders at health systems question the value of FHIR because of the lack of patient adoption of apps and limited use cases. The vice president of IT at one health system said, "We have a small number of apps that we are using through FHIR, but what we have found for the most part is that FHIR doesn’t provide all of the functionality that is needed to do complete workflows. … One of the big limitations with FHIR is that recently, there has been a lack of support for two-way data. Most FHIR apps pull data out, but the ability to write data back is still limited for us."
Providers want better ways to share patient data: When asked what interoperability use cases EHR companies should focus on in the next two to three years, provider organizations primarily spoke about enhancements to patient-record exchange. They would like that exchange to be bidirectional and would like parsing through that data to be easier.
“[Our vendor] needs to pay the most attention to sharing records. I would like to have the ability to drill down into a record and send specific data instead of having to send a whole record," said one health system's chief information officer.
Population health is another key area for future vendor focus, particularly around incorporating social determinants of health data, according to the report.