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How Does Health IT Interoperability Affect Patient Safety?

When health IT interoperability is lacking, it affects patient safety through a series of unintended consequences.

By Sara Heath

- According to a recent ONC report, health IT interoperability is a major barrier to patient safety while using technology.


The report, which also explores other health IT patient safety barriers, describes five ways in which interoperability is a roadblock to keeping patients safe and providing quality care while robustly utilizing technology.

Specifically, health IT interoperability issues produce a series of unintended consequences, usually driven by issues matching the patient to their health records or delivering critical patient data to a provider in a timely manner. Through technology glitches and lacking data standards, interoperability issues serve as a notable barrier to delivering safe and quality healthcare.

Lacking HIE data standards, untimely exchange

First, ONC discussed issues with health information exchange (HIE), particularly the issues of incomplete, inaccurate, or untimely exchange.

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These issues can result in patient data matching problems, data quality issues, data integrity loss during data transmission, and technical limitations. Technical limitations may include when a certain HIE may not transmit certain kinds of data uniformly, such as ancillary data.

ONC states in the report that better data standards may be a solution to these kinds of problems. Leading industry groups like the Healthcare Information and Management Systems Society (HIMSS) and the American Healthcare Information Management Association (AHIMA) have both presented options for boosting HIE data standards.

AHIMA recommends standardizing data capture by using existing national standards, increasing the number of primary data elements, and incorporating secondary data Report of the Evidence on Health IT Safety and Interventions 12 elements to accurately identify participants in HIE. HIMSS developed a Patient Identity Integrity Toolkit with resources to enhance understanding of patient identity integrity and the many issues involved in reliably and safely matching patient identity across systems.

ONC also suggests HIEs go the way of the Department of Veterans Affairs, which performs a double confirmation on their part and the part of the HIE to ensure that the data has been sent and received in its full and complete form.

Data presentation and overload issues

The second unintended consequence ONC details is the issues of data presentation and data overload. For instance, some HIEs may have a massive amount of data in its repositories, and that may be too much for a practice’s EHR to process, or for an individual provider to process.

There are also many design issues associated to the amount of data in HIEs, and EHR interfaces may not be well-suited to presenting that data to users.

“Many EHRs are not optimized to manage HIE data,” ONC explains in the report. “Furthermore, many do not employ user-centered design principles in presentation of data. Clinicians may be unsure what data are present or missing from the HIE system. Data presentation issues can negatively impact clinicians’ workflow and their ability to use HIE information to provide and coordinate care.”

As a result, ONC says HIEs and EHRs should need to be better designed for sifting through the data and data adjudication.

“HIE data should be automatically integrated with the user’s local data, along with clear identification of the date and information sources,” the report says. “A suggested workflow improvement included data reconciliation or adjudication support.”

Semantic interoperability

Semantic interoperability is the ability for HIEs and interoperable health device to transmit data within its original context. This not only allows providers to understand the original context in which the data was collected and used, but allows them to better use it for future care encounters with that patient.

Lacking semantic interoperability causes the two aforementioned unintended consequences of interoperability issues including lacking HIE standards.

HIE use issues

Health information exchanges may also have many usability issues, which can center on the following:

  • Workflow and provider preferences not considered in design / implementation of the HIE capability; for example, in how the clinician accesses the information (e.g., separate portal, not integrated with EHR);
  • Lack of confidence in the data, which typically come from providers who are not known to the user;
  • Data not considered reliable, e.g., complete and accurate, and meeting the intended purposes. Clinicians may not consider a reported medication allergy from another provider to be reliable, for example.
  • Lack of financial drivers or an acceptable value proposition; and
  • Lack of an adequate, trained workforce to support HIE use (e.g., administrative, technical, clinical leadership).

When there is lacking HIE usability support, providers cannot adequately exchange and receive health data, making that data’s use very limited.

Lacking interoperability between health devices

The final issue listed in the ONC report includes lacking interoperability between the numerous devices patients may be connected to in a hospital. These devices include technologies like EHRs, infusion pumps, and pulse oximeters, among other tools.

When they are not interoperably connected, these devices create a significant extra burden on healthcare professionals.

“Nurses, for example, have to program and monitor the devices and often spend a significant time transcribing data by hand because the devices are not designed to share information,” the report says. “Manual transcription from one device to another increases the risk of medical errors.”

Going forward, developers need to make these devices according to a set of common standards, such as the Medical Device Plug and Play Interoperability Program. This program outlines a set of standards by which devices should be developed, and helps enable device integration.

According to an ONC blog post written by Andrew Gettinger, MD, chief medical information officer at the Office of Clinical Quality and Safety, this report serves as a way for healthcare professionals to identify problems using their health technologies.

When used in tandem with another ONC-produced report on how to improve health IT, the pair can be used as a roadmap for the future of health technology.

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