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4 Barriers Limiting EHR Use, Health Information Exchange

Acceptance is the first stage on the road to recovery. With that, here are four barriers limiting EHR use and health information exchange.

By Kyle Murphy, PhD

- Despite increases in physician EHR use over the past few years, four major barriers remain in the way of future advancements in health IT adoption.

Barriers to EHR use, health information exchange

This is one of several takeaways from a recent report to Congress by the Office of the National Coordinator for Health Information Technology (ONC).

The report emerged a month after the Centers for Disease Control (CDC) released findings of certified EHR adoption and health information exchange by office-based physicians between 2013 and 2014.

Chief among those findings were that 74.1 percent of these providers had completed the adoption of certified EHR technology (CEHRT) in 2014 — up from 67.5 percent in 2013 — and 32.5 percent were using these technology for information sharing with other providers.

The progress made by office-based physicians, however, provides only a snapshot of physician EHR use and HIE adoption. So what barriers then stand in the way of health IT use playing a more significant role in improving care quality, coordination, and delivery?

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What follows is a look at the four major barriers preventing progress in health IT adoption, use, and exchange according to ONC.

Unsurprisingly, one major barrier is inconsistent EHR adoption across the care continuum, much of which has to do with a lack of incentives for non-primary care providers to invest in health IT:

Under current law, Medicare and Medicaid programs have no authority to provide financial incentives for the adoption of certified EHR technology among psychiatric hospitals, community mental health centers, residential and outpatient mental health and substance use disorder treatment clinics, and non-physician mental health professionals. Only eligible facilities (hospitals and critical access hospitals) and eligible professionals (physicians and dentists, as well as some nurse practitioners, certified nurse midwives, physician assistants in Federally Qualified Health Centers (FQHCs), optometrists, and chiropractors) can currently receive incentives under the EHR Incentive Programs.

For its part, ONC recognized the need for extending EHR adoption and use to behavioral health and long-term post-acute care providers more than a year ago in its Federal Health IT Strategic Plan. To be expected, limited health IT infrastructure across the care continuum hampers health information exchange as patients transition between clinical settings.

"Hospitals' rates of both sending and receiving patient summary of care records to and from long-term care and behavioral health care providers were considerably lower than electronic exchange with outside hospitals and ambulatory care providers," the ONC report states.

The federal agency also attributes these disparities in health IT adoption and use to a lack of health IT transparency — that is, the "persistent lack of transparency and access to reliable information about health IT products and services, including for electronic health information exchange."

According to ONC, increased health IT transparency should lead to improved health IT interoperability:

This lack of transparency and reliable information about health IT products and services impacts the efficient functioning of health IT markets, reducing opportunities to advance interoperability through vigorous competition and innovation in the marketplace. In particular, providers cannot effectively compare solutions and select those that meet their needs when they lack access to basic information about the costs, limitations, and trade-offs of competing health IT products and services. This includes capabilities that will enable them to participate in new care delivery and payment models that leverage health information exchange and analytics. In addition, providers are more likely to become "locked in" to technologies, which diminishes incentives and opportunities for health IT developers to improve their technologies and compete to deliver more innovative, more advanced, and less expensive products and services that meet the needs of providers, patients, and the health care system.

A lack of interoperability represents the second major barrier to progress in health IT adoption, use, and exchange. The ONC report identifies three challenges contributing to a lack of health IT interoperability.

"First, there is variation in how standards are tested and implemented,"  the report states. "Second, there is significant variation in how health IT stakeholders interpret and implement government policies and legal requirements. Third, health IT stakeholders are reluctant to embrace supportive business practices that can reinforce and expand collaborative data use arrangements and foster meaningful consumer engagement and action."

As noted by ONC, these challenges are "interrelated." For example, hospitals report limited EHR capabilities — either the lack of EHR technology or capable EHR technology — as the leading causes of limitations in health information exchange.

Contributing to a lack of interoperability is the absence of nationwide policies for supporting health information exchange, claims ONC in the report.

"Local or regional areas have done this through contract vehicles; however, to get to nationwide interoperability, stakeholders need to have common policies and practices that hold entities accountable and that federal agencies can require through their programs," it observes.

Additionally, the federal agency points to data blocking as a contributing factor:

Evidence and experience suggest that information blocking is occurring and may become even more prevalent as technical and other challenges of sharing electronic health information are reduced. Inevitably, some market participants will regard this trend towards greater data liquidity as contrary to their individual business interests and will seek to retain control over electronic health information in ways that limit its exchange and use.

The two remaining barriers focus on health data security and health IT safety and usability.

For the former, variation in state and federal privacy laws create a complex legal landscape for providers considering health information exchange. "The variation causes confusion among exchange partners, and makes it difficult and expensive to harness technology to ensure privacy compliance. This, in turn, impedes interoperability," ONC claims.

For the latter, questions about health IT safety and usability have raised the need for stakeholders to come together and share best practices. For its part, the federal agency views collaborative efforts as the means to ensure that health IT use does not negatively impact patient safety.

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