Why Do All EHRs Still Lack Interoperability? How Does Congress’ 21st Century Cures Act Help?

by | Published on Oct 16, 2017 | EHR/EMR

The electronic health record has many advantages – it simplifies the medical record retrieval and review process, and is expected to enable easy sharing of the records when needed. EHRs have been implemented across hospitals in the U.S, with 96% of them having a federally testified and certified EHR program. Almost 80% of physicians also have a certified EHR system in place. However, interoperability or the ability to share clinical data across health systems and EHRs continue to be a challenge and hinders EHR optimization. For two EHR systems to be interoperable, they must be able to share data and then present that data in a way that the user can understand.

Why is interoperability so challenging?

  • EHR systems in use today across the United States are distinct, with different technical specifications, functional capabilities, and clinical terminologies. These differences make the creation of one standard interoperability format for sharing data difficult.
  • Even EHR systems built on the same platform may not be interoperable because they are highly customized to a healthcare organization’s specific preferences and workflow.
  • For two EHR systems to be truly interoperable, the data transmitted must be standardized. Lack of standardized data is a major issue with the U.S. healthcare system.

According to the Healthcare Information and Management Systems Society, there are three levels of interoperability:

  • Foundational: In this case one EHR system can receive data from another system, but needn’t necessarily be able to interpret it.
  • Structural: At this level, information can be exchanged between IT systems, and interpreted at the data field level.
  • Semantic: This is the highest level of interoperability. Here 2 or more systems can exchange information, and the exchanged information can be used.

While the above mentioned are issues related to technology, there are other reasons too that hinder interoperability of EHR systems.

  • Healthcare providers as well as EHR vendors have been accused of blocking information, or intentionally interfering with the information flow between various electronic health record systems.
  • Often, health systems force providers to adopt and use specific EHR technology instead of going the more simple way of making it possible to collaborate across various EHR technologies.
  • Moreover, patient health information is either selectively shared or not shared at all by health systems including hospitals with a view to control patient referrals and having exclusive access to patient data and thereby enhancing their market dominance.
  • EHR vendors also indulge in information blocking. They either charge high fees for providing health information exchange (HIE), or design products that have limited interoperability.

In view of these concerns, the ONC (Office of the National Coordinator for Health Information Technology) released a report to Congress that contained evidence of this information blocking trend in the healthcare industry. Consequently, by the end of 2016, Congress passed the 21st Century Cures Act that made it more difficult for providers and vendors to engage in information blocking. This bipartisan legislation imposes penalties up to $1 million on EHR developers, providers, and networks that block information or engage in any other action that obstructs the appropriate exchange, access, and use of electronic health information.

It is clear that for EHR systems to be really interoperable and usable, all stakeholders in the health industry should collaborate effectively. EHRs are very important because they contain valuable data that would help with improving patient care, research, and population health.

  • Vendors should avoid developing poorly designed electronic health records that become burdensome for providers.
  • According to the AMA (American Medical Association), EHR vendors should focus on developing EHRs that help reduce cognitive workload, facilitate digital and mobile patient engagement, and expedite user input into product design and post-implementation feedback.
  • Organizations in the health sector need to develop a culture of trust. Industry groups must convince health organizations that EHR and IT investments are worthwhile by providing clear, comprehensive and mutually beneficial health information exchange frameworks.
  • Good governance practices can be put in place including organizational policies related to information security, data use, privacy, technical standards and other factors that could affect the exchange of information.

According to the ONC, it would be 2021 to 2024 before the U.S. health system achieves interoperability. Along the path of achieving this goal, there exist many barriers that need to be addressed including physician dissatisfaction with EHRs, cost involved, and overregulation. To make patient health information available across the healthcare sector, providers, EHR vendors and other stakeholders need to be a part of the interoperability drive. The federal government can assist in this by providing stronger incentives for vendors as well as providers.

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