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EHR Integration a Challenge for Hospital Interoperability

ONC data brief lists EHR integration of external data sources as a top challenge for hospital interoperability.

By Kyle Murphy, PhD

- EHR integration remains a sticking point for hospitals working to advance interoperability and health information exchange.

EHR integration and hospital interoperability

The Office of the National Coordinator Health Information Technology (ONC) published new data on providing insight into the interoperability of hospital health IT and the use of electronic forms of information sharing. While the information indicates increases in the ability of hospitals to find, send, and receive clinical data electronically, it indicates the opposite for the ability to use or integrate this data.

For the former categories, the percentage of hospitals finding clinical information electronically rose from 48 percent in 2014 to 52 percent in 2015; sending this information, from 78 percent in 2014 to 85 percent in 2015; and receiving this information, from 56 percent in 2014 to 65 percent in 2015.

Over the period of time, the ability of hospitals to use or integrate clinical information electronic dropped from 40 percent to 38 percent, which the authors of the data brief consider negligible.

"Rates of integrating information did not significantly change between 2014 and 2015; about 4 in 10 hospitals had the capability to integrate data into their EHRs without manual entry," they write.

According to this latest ONC data brief, the challenge with hospital interoperability lies less with moving patient health data between endpoints and more with what becomes of that information once it reaches its destination.

As of 2015, 82 percent of hospitals (non-federal acute) actively exchanged laboratory results, radiology reports, clinical care summaries, or medication lists with external providers (e.g., ambulatory practices, other hospitals), up from 76 percent and 62 percent in 2014 and 2013, respectively. Since 2008, the percentage of hospitals electronically sharing these types of data doubled from 41 percent to today's figure.

The authors of the report mark 2011 as a turning point in setting the stage for significant annual increases — the implementation f the Health Information Technology for Clinical and Economic Health Act likely had something to do with that.

The positives, however, quit there. Despite the high figures for electronically sharing certain types of patient health data, only half of providers are able to use clinical information from external sources. When asked how often their providers make use of these data sources, the numbers broke down as follows:

  • Often (18%)
  • Sometimes (35%)
  • Rarely (20%)
  • Never (16%)
  • Do not know (11%)

The data brief includes a follow-up question as to the reasons why providers aren't taking advantage of clinical data from external sources and the leading cause was a lack of EHR Integration — that is, the ability to view this information in the EHR as part of a clinician's workflow (53%). Following closely behind was the difficulty of integrating external information into the EHR system and the information being unavailable when needed (40%). Rounding the remaining known reasons were information appearing in non-useful formats and distrust about data accuracy.

Reasons for limited use of external patient health data

As for top barriers to interoperability and information sharing, still leading the way was the technical one preventing exchange partners from receiving information electronically (55%). Coming in a close second was the technical barrier of an exchange partner not having an EHR or health IT system (53%). In fact, the top five reasons for limited interoperability all fell under the technical type — finding provider addresses (49%), exchanging across different vendor platforms (46%), and matching/identifying patients correct (33%).

Non-technical barriers to interoperability included cumbersome workflows, a lack of useful data delivered to recipients, additional costs to exchange with external providers, and a culture of non-sharing.

"Continued increases in the interoperable exchange and use of health information from outside sources along with the availability of information are important to the success of care transformation efforts nationwide, which will likely expand with the implementation of the MACRA. However, there is still significant progress to be made to improve the use of exchanged information and to address barriers to interoperability," the authors concluded.

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