- Healthcare organizations are still struggling with the basics of health information exchange and interoperability, with more than 40 percent of respondents to a new Black Book Research poll admitting that they have significant difficulties exchanging data with other providers.
Data standards issues, EHR vendor interoperability concerns, and integration shortfalls are all preventing providers from using external data for clinical decision-making, leaving organizations unprepared to tackle the population health management and quality reporting projects required for success under value-based care.
The poll of more than 3300 EHR users revealed widespread concerns about the ability to leverage big data for enhancing patient care.
While 81 percent of physicians operating within integrated delivery networks look to their core health system’s EHR to enable population health management and value-based care, those health systems are not having an easy time of generating complete, accurate, and trusted data sources.
A quarter of respondents said they are simply unable to use any data received electronically from external sources. Twenty-two percent said the data they receive is not in a format that is useful to them. Seventy percent of hospitals do not use patient information from outside of the EHR because they cannot integrate external data into their EHR systems’ workflows.
And twenty-one percent of physicians stated that even when they can view patient data, they do not trust that it is accurate enough to use for decision-making.
As a result, providers continue to be skeptical about their ability to engage in value-based care while meeting regulatory requirements such as MACRA. Eighty-two percent of independent physicians questioned their data analytics competencies, stating that they are not confident they have the data analytics skills and interoperability capabilities to take on financial risk.
"Physician groups continue to lack the financial and technical expertise to adopt complex EHRs which are compulsory to attain higher reimbursements by public and private payers,” said Doug Brown, Managing Partner of Black Book.
Instead of trying to address these technology issues themselves, independent physicians are likely to seek the protection of larger health systems. Ninety-two percent of hospital executives said they are anticipating a flood of physician acquisitions in 2017 as practitioners seek protection from the pressures of MACRA.
"Integrated delivery network EHRs are the future's source for trusted provider data integration and leading to the increase in physician EHR replacements in line with the hospital system,” Brown added. EHR replacements in recently acquired physician practices are increasing by 52 percent, he said.
But acquisition and employment may not be a silver bullet for physicians looking to become part of a larger technology network. Even when integrated delivery networks actively pursue interoperability with business partners, data exchange problems often abound.
In a previous Black Book survey from April of 2016, fifty-seven percent of organizations said their EHR vendors are responsible for data siloes, connectivity defects, or active information blocking that derailed efforts to move patient data across organizational lines. Instead of waiting for vendors to fix these issues, many providers said they were starting to develop their own private health information exchange organizations to connect regional partners.
EHR vendors spent the majority of 2016 combatting user perceptions that they were less concerned about interoperability than about turning a profit, with varying degrees of success.
While major vendors comprising 90 percent of the health IT market made a public pledge to interoperability at the beginning of the year, the end of 2016 saw the 21st Century Cures Act develop a framework for the first penalties for deliberate information blocking – applicable to vendors and providers alike.
The new Black Book poll indicates that providers may be more worried about unintentional data blocking, however. The concerns about data integration and the technicalities of data exchange seem less like a purposeful scheme to prevent the movement of patient records and more like a continuation of the fundamental fragmentation of a free market.
Even the Office of the National Coordinator, in its landmark 2015 report on data blocking, conceded that vendors aren’t always culpable for the interoperability problems that often give EHRs a bad name.
“Many actions that prevent information from being exchanged may be inadvertent, resulting primarily from economic, technological, and practical challenges that have long prevented widespread and effective information sharing,” the report said.
“Further, even conscious decisions that prevent information exchange may be motivated by and advance important interests, such as protecting patient safety, that further the potential to improve health and health care. These interests must be carefully balanced with the potential benefits from sharing of electronic health information.”
Vendors have been quick to seize on this point. In its response to the report, the EHR Association (EHRA) admitted that the industry largely believes in information blocking, but added that “in many cases, there is no intent to interfere, but rather a series of events that result in less data exchange than desired by some parties (e.g., conflicting provider business models, misalignment of objectives/priorities, lack of funding, limited infrastructure, etc.).”
The participants in the Black Book poll appear to be running into these same obstacles, but Brown notes that customers may soon be able to take a more positive view of their EHR products.
Vendors are actively investing in new interoperability technologies, including APIs and FHIR, that may make it easier to overcome some of the integration and data formatting problems that are limiting the usefulness of external information.
"As inpatient organizations implement optimized EHR software that uses FHIR to advance interoperability and HIE, the entire provider network gains the data exchanging functionality to better serve patients," he said.
Major vendors, including Epic, Cerner, and Allscripts, have already adopted FHIR as a way to ease interoperability between products. In December, the three companies joined the ONC in demonstrating how the Fast Healthcare Interoperability Resource could smooth the flow of data across organizations and put personal health information into the hands of consumers.
The ONC considered the demo to be the first real-world embodiment of the 2016 interoperability pledge, and a sign of better things to come for the healthcare community.
“We are incredibly encouraged by the advances our private sector partners have made to unlock data and empower individuals when it comes to accessing their medication information,” said former National Coordinator Vindell Washington, MD, MHCM.
“This is just the latest example of the health IT progress and infrastructure that has resulted from public-private collaboration over the past eight years to improve the health and care of individuals and communities.”
But providers who are staring down MACRA reporting periods and attempting to engage in value-based contracting may wish to see faster progress. Risk-based population health management is slated to become a major influence in 2017, says HIMSS Analytics, which doesn’t give vendors and their customers much time to work out lingering interoperability kinks.
Vendors and providers will need to collaborate to develop meaningful EHR workflows that can incorporate patient data from external sources if the healthcare system is to succeed with value-based care. Doing so will likely require some flexibility from both parties as well as a strong commitment to the shared goal of improving the quality and coordination of patient care.