- About 70 percent of acute care hospitals participated in at least one health information exchange (HIE) network with nationwide scope in 2017, according to a new ONC data brief evaluating methods used to enable interoperability among non-federal acute care hospitals.
ONC used data from a nationally representative 2017 American Hospital Association (AHA) IT Supplement survey to identify methods hospitals use to exchange summary of care records. The federal agency also offered insight into hospitals’ rates of participation in HIE networks and variations in the ways hospitals share data.
“Hospitals’ electronic exchange of information is a complex process involving a variety of methods,” wrote report authors. “Although a majority of hospitals used more than one electronic method to send and receive summary of care records, most hospitals still used both paper-based and electronic methods.”
According to 2017 data, about 78 percent of hospitals used more than one method to electronically and routinely send summary of care records, while 61 percent routinely received summary of care records electronically.
“Hospitals that used more electronic methods to routinely receive summary of care records were more likely to have patient health information electronically available at the point of care and subsequently use this information for decision-making,” noted ONC.
ONC also found hospitals commonly used health information service providers (HISPs) to share summary of care records. About half of hospitals participated in both a national and state, regional, or local health information organization (HIO).
“Overall, hospital participation in health information networks was sizable,” wrote the federal agency.
About 60 percent of surveyed hospitals participated in Surescripts, while about a quarter of all hospitals participated in e-Health Exchange. Similarly, nearly 25 percent of surveyed hospitals participated in DirectTrust.
Fourteen percent of surveyed hospitals participated in CommonWell in 2017, while only 8 percent utilized Carequality.
Over 90 percent of hospitals that used six or more methods to electronically receive summary of care records had patient health information available at the point of care and used this data for clinical decision-making.
While rates of health data exchange were high in 2017, providers in some care settings and geographical areas shared less data than others. Overall, small, rural, and critical access hospitals (CAHs) had lower rates of health data exchange than their larger, more urban counterparts.
“While two-thirds of small, rural and CAHs participated in national networks, three-quarters of their counterparts participated,” wrote ONC. “The gap was even wider for state, regional, and local HIO participation. These gaps likely reflect broader disparities that exist in the adoption of health information technologies between small, rural, and CAHs and their counterparts.”
Small and rural hospitals were about half as likely to routinely send and receive summary of care records using only electronic methods compared to larger, more urban hospitals. Furthermore, while 76 percent of large and medium-sized hospitals participated in state, local, or regional HIE networks, only 62 percent of small hospitals did.
“Instead, they largely relied on paper-based methods to routinely send and receive summary of care records with outside organizations,” ONC stated.
About a quarter of small, rural, and CAHs exclusively relied on paper methods to receive summary of care records.
“The number of exchange methods hospitals need to ensure that they have information electronically available and subsequently used, contributes to the complexity and costs of exchange,” stated ONC. “These complexities and increased costs are often cited as barriers to interoperability.”
The Trusted Exchange Framework and Common Agreement (TEFCA) may serve as a way to simplify health data exchange through the use of health information networks.
While existing HIEs and HIE participants may need to make changes to their business processes in order to comply with TEFCA requirements, the framework may help to promote standardization to reduce and simplify different methods of data sharing.