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Lack of EHR Interoperability, API Use Hinder Value-Based Care

The current state of EHR interoperability is insufficient to support healthcare’s transition to value-based care, according to industry leaders.

Problems with EHR interoperability stagnate progress toward enabling a value-based care system.

Source: Thinkstock

By Kate Monica

- Almost a decade after healthcare organizations across the country began investing in EHR technology, problems with EHR interoperability still obstruct care coordination, health data exchange, and clinical efficiency.

Consistent, widespread application programming interface (API) implementation and use may help to overcome existing barriers to interoperability and accelerate the transition to value-based care, according to testimony from Adventist Health Chief Transformation Officer and Population Health Services Chief Medical Officer Nishant Anand, MD at a September 13 hearing for the House Energy and Commerce Subcommittee on Health.

“There are real challenges that we face regarding interoperability, sharing enabling technology with our physicians, and navigating the care of our patients,” said Anand in written testimony.

Anand testified about existing barriers holding back the transition to value-based care alongside other industry leaders including Healthcare Leadership Council President Mary Grealy, Covenant Health Partners Chief Medical Officer Michael Robertson, MD, and others.

Problems with interoperability make it difficult for providers to participate in value-based arrangements, Anand maintained. Furthermore, the current lack of interoperability in healthcare complicates patient access to information.

Efforts to advance interoperability should be patient-centered to ensure the changing healthcare system is geared toward improving patient health outcomes and care quality.

“As patients navigate throughout the continuum of care — through physician offices, hospitals, same-day surgery centers, or community clinics — their records should be easily transferrable between all organizations,” maintained Anand. “In an ideal state of interoperability, patients would not be placed under the burden of having to seek their medical records from different providers.”

One of the most significant roadblocks inhibiting progress toward improving interoperability nationwide is the lack of a single patient identifier, he said.

“The lack of a national patient identifier makes it difficult for data to be exchanged seamlessly between organizations,” said Anand. “Regardless of the electronic system, there will always be variability in the registration and data entry processes at each organization. This will prevent the health care industry from achieving full positive identity matching.”

Lack of competition within the EHR marketplace has also stagnated progress toward advancing interoperability. Expensive, monolithic EHR systems dominate the industry and burden healthcare organizations with added financial strain.

Anand offered ONC and other federal entities six recommendations to address these problems with interoperability.

First, Anand recommended ONC designate an open application programming interface (API) standard for HER systems to ensure APIs are implemented consistently. Open API standards can also help to foster fair market adoption across EHR systems from different vendors.

Next, he urged ONC to ensure providers can connect any third-party application to their EHR system using API and other industry standards. Providers should be able to use these third-party applications without obtaining permission from their EHR vendor, or pre-registering the application with their vendor.

Anand also suggested APIs support bulk data extract and real-time data update and exchange to streamline health data sharing.

In support of streamlined data sharing, EHR vendors should not be able to put limits on the data extracted or the frequency of data requests.

Finally, Anand recommended certified EHR vendors be required to disclose all known material limitations including fees and costs associated with their API’s functionality, app integration services, and app integration capabilities.

“By taking these steps, ONC will facilitate the development of applications that can provide clinical decision support and other tools that providers can use to improve the quality and cost effectiveness of care. It will also enable the exchange of data between different EHR systems,” said Anand.

In addition to problems with interoperability, Anand also pointed to outdated Stark Law regulations and the lack of alignment between payment incentives in value-based models as obstructing the transition from a fee-for-service system to a value-based care system.

Reforming existing regulations to support care coordination will help to position ACOs for success and allow providers to better serve the needs of Medicare beneficiaries.

 “To share technology enablement services with providers, we must overcome the barriers to interoperability,” said Anand.

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