The problems with electronic sharing of consumer health information continue to plague the health care field. The concept of “meaningful use” and interoperability of health care records was introduced in 2009 with the Health Information Technology for Economic and Clinical Health (HITECH) Act – and we don’t appear to have made much progress since then. I was just at one of my optometrist’s offices – and was informed I couldn’t order glasses until they got the paper prescription from the other office. I met this week with the managers who are running a health home with paper records that shuffle around with the consumer, from one professional to the next. I conducted a recent focus group with emergency room staff who said their primary communication with consumers’ medical care givers was by fax.
Do I need to list the problems with these situations? Bad consumer care with medication mismatches and overtesting. Increased readmissions. Missed opportunities for optimized decisionmaking. Poor efficiency and productivity. This situation puts specialists organizations that are independent of large health systems at a distinct disadvantage. And obviously, the organizations that can make data sharing work with their payer and provider partners are organizations that will have a huge competitive advantage.
But how to make this happen? A recent Government Accountability Organization (GAO) study outlined five key shortcomings that current initiatives intent on helping achieve health information interoperability have, in their recent report, Interoperability Initiatives Focus On Facilitating Patient Access To Electronic Health Records. Those five key challenges include:
Insufficiencies in health data standards – Many interoperability initiatives have attempted to facilitate different information technology systems and software applications, but without specific health data standards. This isn’t a winning proposition as the different data formats, data standards, and in some cases, different terminology, obstruct high level interoperability.
Variation in state privacy rules – The standards for personal health information privacy vary from state to state, an interoperability challenge that has earned the nick-name “baby-HIPAAs” (see The ‘Baby HIPAA’ Conundrum). The end result is that some health data can’t be exchanged state-to-state (“opt-in” and “opt-out” states often won’t share mental health data), or provider organizations don’t have the technical or administrative capability to meet the requirements for exchanging it.
Accurately matching patients’ health records – A specific difference in data standards between EHR-systems is the method for identifying consumer health records. Some current methods (name and date of birth for example) often aren’t specific enough to distinguish between separate consumers. And, when that system attempts to communicate with a different system using different criteria (e.g Social Security numbers), there is often no way to line up a consumer’s name in one system with that consumer’s SS number in another system.
Costs associated with interoperability – Interoperability costs money, and it costs money to achieve every time an organization needs to make a custom connection with a new system outside their own. In addition, the legal fees associated with establishing EHR interoperability that protects both patient privacy and the organization sharing the data can be significant.
Need for governance and trust among entities – The above challenges have led to an environment of distrust, even among participants in the same interoperability initiatives. Part of the problem is that many of these health information exchanges are non-federal. There is currently a lack of, and a need for, federal guidelines and agreements that will facilitate information sharing.
The GAO’s recommendations to address these challenges sound simple – data standards need to be both specific and universal – and EHR systems need to be highly customizable to create provider organization buy-in. For executives teams that are currently shopping for a new EHR system, finding one that offers customization going forward, supports your workflow and decision-making, and comes with access to more and more of the information needed to adapt to the above challenges, should be a top priority (see Knowledge Base Resources: The Age of Peer-to-Peer Learning, Engagement and Collaboration).
What else could be added to the above list? According to my colleague, OPEN MINDS Senior Associate Sharon Hicks, consumer education is also a high priority.
In addition to solving the technical challenges that impede sharing of health information, consumers need to fully understand how their personal health data may be accessed by prospective employers, health insurers, etc. Even in places with national health solutions, people with the means to do so, often seek care for sensitive issues privately to keep those data out of the hands of the national data banks. The balance between privacy of an individual and a clinician’s needs can only be bridged by ensuring that the individual receiving care is part of the overall process. Finding an EHR that includes the potential to add the voice of the patient adds yet another challenge to the procurement process.
For more, make sure to mark your calendar for The OPEN MINDS Technology & Informatics Institute on November 10-11, 2016, in Washington D.C., and the session by my colleague Joseph P. Naughton-Travers, Ed.M., How To Take Your Ideal EHR From Plan To Reality: Software Selection & Implementation.