Electronic Health Records

GAO: Lack of data standards foils EHR interoperability, HIE

Insufficient data standards continue to cause difficulty for providers attempting to exchange health information, says a new report by the Government Accountability Office (GAO), despite the efforts of CMS and the ONC to streamline the methods and reduce the costs of sharing patient information.  After interviewing stakeholders in four states, GAO found that data fragmentation still persists among providers, contributing to a lack of care coordination that costs the beleaguered healthcare system up to $226 billion per year.

“To deliver coordinated care, a physician and other members of the care team must access and share health information from multiple settings,” the report explains. “Providers may share clinical data using manual methods such as faxing paper records, but these methods can be time consuming and costly and are often unavailable at the point of care. Lacking the ability to receive and store structured data in their [EHR] systems, providers may not be able to easily search for the information they need or electronically transmit the information effectively to another EHR without manual efforts.”

While the purpose of the EHR Incentive Programs has been to encourage health IT adoption to shift the industry away from these cumbersome paper-based methods, even after years of incentives and guidance from federal agencies, the healthcare system has been lacking in its HIE and interoperability capabilities.  Providers in Georgia, North Carolina, Minnesota, and Massachusetts all benefit from ongoing state-level activities to further information exchange, GAO says, but the challenges remain significant.

In addition to privacy and security concerns, the cost of conducting data exchange, and worries over matching patients across multiple systems, a dearth of widely accepted data standards continues to be a major obstacle.  Providers interviewed by the report’s authors noted that patient allergy and allergic reaction data was often highly scattered and lacked approved nomenclature that would allow EHR systems and end users to easily interpret critical information.

One provider explained that “some EHR systems classify an allergic reaction as a side effect, while other EHR systems classify the same reaction as an allergy.”  This makes it difficult for a physician to be sure she has read all the information related to a patient’s allergy, and may cause patient safety risks if the physician accidentally prescribes a medication that produces an adverse event.

While 2014 is a big year for data standards, with HHS ramping up EHR certification requirements and putting its weight behind data standards and interoperability roadmaps, the end result of these efforts continues to be murky.

“First, while the 2014 edition certification standards may lead to a greater ability to exchange information and HHS has tested the implementation of the standards among certain providers, HHS officials told us that the extent to which the standards will lead to widespread improvements in electronic health information exchange will remain unclear until a larger number of providers begin using technology that is certified to the standards,” the report notes. “Second, some concerns regarding standards were not addressed through the 2014 edition, and several providers we interviewed said there is a need for standards that would allow all certified EHR technology to be interoperable so all types of health information could be electronically exchanged across providers.”

In response to the comments presented in the report, HHS said that it concurs with the GAO’s findings that data standards must be increased in order to foster better care coordination.  HHS has started to develop interoperability milestones to guide providers towards better use of standards, and also provides funding opportunities to states interested in boosting HIE and data exchange.

“According to CMS and ONC officials, ensuring progress in providers’ ability to electronically exchange information is critical for the effective implementation of the EHR programs,” the report concludes. “Without a sufficient focus on exchange—including specific, prioritized actions with milestones and time frames—CMS and ONC run the risk that the desired outcomes of the EHR programs of improved quality, efficiency, and patient safety will be compromised.”


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