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By Sarah C. Threnhauser, MPA

Artificial intelligence, virtual health, digital consumer engagement, digital transformations, and digital dexterity … if you are at the helm of technology strategy for a provider organization today, there are a lot of tech decisions to make in the name of interoperability. Unfortunately, the state of interoperability in the system serving consumers with complex needs continues to prove itself inadequate for the job at hand.

This was made clear to me recently after I read the report, Methods Used To Enable Interoperability Among U.S. Non-Federal Acute Care Hospitals In 2017, from The Office of the National Coordinator for Heath Information Technology. The stats that jumped out at me? About seven in 10 hospitals sent (66%) or received (73%) summary of care records using mail or fax in 2017—and 35% did this often. The most likely hospitals to do this were small (70%) and rural (72%), but even large (61%) and urban (61%) hospitals were relying heavily in mail and fax.

OPEN MINDS Sharon Hicks
Sharon Hicks

Why would this still be the case in an otherwise tech-enabled world? For more, I reached out to the OPEN MINDS team, including Senior Associate Sharon Hicks, who outlined four key reasons why clinical data exchange by fax still exists—quick limited information vs. full records; data entry requirements; information infrastructure gaps; and lack of health information exchange.

Quick limited Information vs. full records—Because the tech infrastructure for fax is already in place, many clinical professionals who need information from one test result will find it faster to simply fax the results between themselves. Ms. Hicks explained:

If my primary care doctor wants to share a lab result with a specialist, then it may be more expedient to have someone in the office fax that specific test result than to send the information through the established data exchange.

Data entry requirements—Unfortunately, a lot of information in a hospital is still stored on paper and not in the electronic health record system (EHR). While full interoperability will depend on getting most hospitals and health care organizations to a completely paperless state, the field isn’t there yet. Ms. Hicks explained the benefits of this move:

When, as a field, we moved away from handwritten charge sheets, it added complexity to the process. For example, it is much easier to grab a piece of paper and write a note than it is to log into a system and page through all the areas that require documentation to create a record for the billing system. The benefit to the larger system is great, but not all team members understand that benefit.

Information infrastructure gaps—Last year a study that looked at interoperability in health care systems judged hospitals on “data integration, reception, distribution and finding.” The findings? Just 29.7% of hospitals met all four metrics (see Progress In Interoperability: Measuring US Hospitals’ Engagement In Sharing Patient Data). For many, the resources to fully share data bi-directionally simply isn’t available. Ms. Hicks explained:

Unless all the providers organizations involved are connected to some health information exchange, the process for sharing data is often something that requires assistance from an information technology professional. For example, the process to set up a secure file transfer protocol (SFTP), which assures compliance with privacy and security rules, may be outside of the capability of a primary care office.

David Wawrzynek

OPEN MINDS Senior Associate David Wawrzynek added to this, noting:

Not all organizations have the capacity in their EHR to send and/or capture electronic records. Either it is not functional in their systems, or they have not chosen to turn it on, or they do not have the time, energy, or resources to implement it.

Lack of health information exchange—Ms. Hicks noted that efficient data exchange is the ability to parse specific pieces of information from a record, indicate where that specific information should land, transmit that information securely, and have it land in the health record of the receiving clinical professional. Unfortunately, less than half of specialty provider organizations have health information exchange (HIE) capabilities and less than a third use clinical decision support tools or population health management tools (see IT Spending Follows The Money). Ms. Hicks explained:

HIE also requires that the receiving provider organization gets some notification that specific information is now available in their system. When I send a fax, I know that some person in the office is responsible for clearing the fax machine and therefore I feel confident that the receiver is going to get the information. Ultimately, we need to embrace the next evolution of electronic health systems (interoperability and common language sets) before we see the true value of data exchange.

George Braunstein

OPEN MINDS Senior Associate George Braunstein also noted the challenge of HIE, especially when smaller organizations are working with larger (better-funded) organizations. He noted:

Some smaller community provider organizations either do not have electronic health record software or have a legacy system that is not very robust. Therefore, when sending or receiving hospital records, they may need paper copies. Also, this report states that most hospitals use multiple means of sharing information, including faxes and mail. That likely means that some hospitals with robust record software capacity share records with other hospitals and community clinics that cannot download their software.

For more on the state of technology and data exchange in the health and human services market, mark your calendar for October 28-30, when we will host The 2019 OPEN MINDS Technology & Informatics Institute, with a focus on tech tools executive teams needs to move their organization from the concept of value-based reimbursement, to success in the new financial normal.

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