- Advancing health data exchange is a top priority among stakeholders in the private and public sector.
Health IT companies including MEDITECH and Epic have made efforts to expand interoperability and promote health data exchange among users, while ONC is in the process of finalizing and implementing a trusted exchange framework and common agreement (TEFCA) to standardize exchange across the industry.
While much of the national dialogue in health IT use centers on data exchange, little is known about what kind of information providers most often send, receive, view, and value when engaging in the practice.
A new National Health Statistics report from CDC provides the first glimpse into how providers nationwide utilize health data exchange in day-to-day operations.
Yang et al. gathered and analyzed data from the 2015 National Electronic Health Records Survey (NEHRS), which included responses from a nationally representative sample of 10,302 nonfederal, office-based physicians.
As part of the survey, physicians were asked about their activities related to sending, receiving, integrating, and searching for protected health information (PHI) electronically.
About 1,301 respondents reported sending PHI electronically. Meanwhile, 1,525 respondents received PHI. Physicians were asked about whether they sent or received medication lists, patient problem lists, medication allergy lists, imaging reports, laboratory reports, registry data, referrals, and summaries of care.
In addition to these eight types of information, physicians who received PHI were asked whether they received hospital discharge summaries and emergency department (ED) notifications.
“Having this information is a next step for research on EHR interoperability because it provides insight into the type of PHI electronically shared among office-based physicians who sent, received, integrated, or searched for PHI electronically in 2015,” stated researchers in the report.
Ultimately, researchers found the most common type of PHI sent among office-based physicians is referral information, with about 68 percent of physicians sending referrals.
Lab results and medication lists also topped the list, with about 67 percent and 65 percent of physicians sharing the information, respectively.
Meanwhile, the most commonly received PHI among physicians were lab results, with over 78 percent of physicians reporting receiving this data through health data exchange. Imaging reports and medication lists were also listed as being common by a majority of physicians who received information through health data exchange.
Researchers also analyzed which types of PHI physicians most often integrated into patient EHRs.
“Among office-based physicians who integrated PHI electronically, the three most commonly observed integrated types were laboratory results (73.2 percent), imaging reports (49.8 percent), and hospital discharge summaries (48.7 percent),” noted researchers.
The least commonly integrated types of PHI included registry data, problem lists, and medication lists, with less than 35 percent of providers integrating each type of information into patient EHRs.
Finally, researchers assessed the type of information physicians generally search for in EHR systems.
Medication lists and medication allergy lists were the most frequently sought information, with 90 percent and 88 percent of physicians searching for the data, respectively.
Physicians also frequently searched for hospital discharge summaries, with 80 percent of respondents reporting searching patient EHRs for the information.
“These are the first national estimates of PHI type according to the aspects of interoperability among physicians with EHR systems, and these estimates can potentially be used as a benchmark for future studies,” wrote researchers.
“Combined with measures of electronic sharing of PHI by physicians, information on the specific type of PHI shared electronically among office-based physicians will assist in tracking progress outlined in the federal plan for achieving interoperability,” the team concluded.
Identifying which types of information providers are most likely to send, receive, search for, and integrate into patient EHRs sheds light on which aspects of care delivery will most likely be affected by improvements in interoperability.
Additionally, pinpointing the kind of information providers most often search for provides insight into which kind of clinical information is most necessary for enabling well-informed clinical decision-making.
UPDATE (8/30/2018): The DirectTrust Clinicians Steering Workgroup responded to the findings providing context about the 2015 dataset used to evaluate health data exchange.
Co-chairs Holly Miller MD, MBA, and Steven Lane MD, MPH, submitted the following comment:
In 2018, Direct messaging alone accounts for over 25 million messages a month, a 200% increase over the 2015 CDC estimates. Direct messaging started as an ONC-funded initiative in 2010 with growing adoption in 2015. At that time, national query-based exchange efforts like CommonWell and the Carequality framework were just getting off the ground. This study highlights the importance of “pushing” data - referrals and lab results were both identified as being “sent” by clinicians and represent the most traffic. Only Direct messaging allows a way to send such messages without significant cost or effort. Today healthcare providers and organizations are sharing protected health information to deliver higher value care. We look forward to continuing to increase interoperability using Direct messaging and other secure technologies to positively impact patient care and outcomes in support of achieving the quadruple aim.