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According to the Office of the National Coordinator for Information Technology (ONC), nearly 95 percent of hospitals and 90 percent of office-based physicians have adopted an electronic health record (EHR) system. Despite the growth in EHR technology and adoption, these systems continue to contribute to data silos that make interoperability a significant challenge.
Interoperability is crucial to accessing patient data for proactive care delivery and better outcomes. EHRs and other Health IT (HIT) systems must be able to communicate with each other to support accurate, efficient, and meaningful exchange of clinical data.
The 2019 Medicare and Medicaid Promoting Interoperability Programs (IP) (formerly known as meaningful use) are designed to incentivize EHR interoperability among providers. The program’s recent overhaul and increased push for EHR interoperability comes in the wake of continued hospital consolidation and the growth of health information exchanges (HIE). The reality is that interoperability, information exchange, and data sharing across disparate EHRs and other HIT systems is a mess because of numerous factors that include the following:
- Lack of patient identification across HIEs
- Lack of payer participation in data sharing
- The high cost of integration
- Lack of communication standards across disparate EHRs
There are certainly other factors that contribute to the current EHR interoperability challenge, but understanding these four primary concerns and the solutions to these challenges points the way to greater interoperability. Pointing out problems without solutions is counterproductive, so we’ve listed a number of solutions that are showing great promise in sorting out the EHR interoperability mess.
Reason #1: Patient Identification Standards Across HIEs
One of the major challenges to true EHR interoperability is the lack of a national patient identifier (NPID). This proposed alphanumeric code would be used to uniquely recognize patients within a health register or an EHR system. Unfortunately, it was revoked by Congress due to privacy issues.
The inability to identify patients and match patient records across and within healthcare provider settings is a big problem where EHRs are the primary repositories and means of access to patient and health data. The resulting consequences include inflated healthcare costs, suppression of ideal health outcomes, and a host of safety problems. The latest Pew Charitable Trust Report addresses the scope of the problem, citing the statistic that health care facilities fail to link records for the same patient as often as half the time.
Reason #2: Lack of Payer Participation in Data Sharing
Payers have a tremendous amount of data that would be invaluable to providers working to improve health outcomes. Unfortunately, payers are fiercely protective of that data as it makes up a substantial portion of their profit model. As more payers move from public to private HIEs, it increases the interoperability and integration cost challenges for providers.
Reason #3: Lack of Communication Standards Across EHRs
Hospital consolidation is accelerating, which means that the resulting multi-hospital health systems and health networks are using EHR systems from different vendors. These EHR vendors are often creating proprietary communication and language protocols that make them unable to communicate with other EHRs. Providers of all types and sizes throughout the healthcare continuum must then find ways to integrate the different EHRs both inside and outside of their own facilities.
Reason #4: High Cost of Integration
Healthcare providers are often using multiple health technology systems to track and analyze healthcare PHI data. This leaves them with the challenge of connectivity and integration among large numbers of disparate EHR and HIT systems, which is a significant cost that only the largest healthcare enterprises can afford.
The scope of the challenge surrounding disparate EHR systems where providers must share data is clearly laid out in a recent Healthcare IT News article. The article cited HIMSS data showing health care networks typically engage with up to 18 different EHR platforms. This leads to costly, slow, and error-prone workarounds by hospitals, diagnostic facilities, and other providers that must transmit, receive, and analyze that data.
Ways to Fix the EHR Interoperability Mess
A few technologies show promise for making strides towards interoperability, from cloud-based EHRs to blockchain and, perhaps the most promising, open APIs. Here’s a look at each of these technologies and how they can impact interoperability.
More and more healthcare providers are using cloud-based EHRs to facilitate better communication between applications. Cloud-based solutions offer a centralized platform that can be accessed by hospitals, affiliated practices, and others involved in patient care.
Blockchain for NPID
Blockchain is gaining interest as a way to provide a single source of truth for PHI across disparate systems and databases for interoperability. A decentralized technology that aims to enable secure information storage and data transfer, blockchain could become a foundational element for creating the NPID due to the following:
- Its use of public-key infrastructure (PKI) which provides a centralized identification method
- A method for immutable logs and digital access rules assignment
- Provenance for and offering audit trails (in case of malicious actors) minimize the risk of data loss
One of the most promising ways to address all four of the reasons behind the EHR interoperability mess is via the use of application programming interfaces (APIs). In short, APIs provide the means for disparate applications and systems to communicate with each other. When applied to the EHR interoperability challenge, they can enable data and protected health information (PHI) sharing and communication among different EHRs and HIT systems.
A growing number of healthcare institutions along with the Centers for Medicare and Medicaid Services (CMS) and ONC are touting APIs as a solution to the interoperability challenge. The recent update to the fast healthcare interoperability resources (FHIR) standards developed and proposed by Health Level 7 (HL7) provides and promotes the use of APIs for use by developers for enabling EHR interoperability.
The HL7 organization is actively working to unify healthcare data standards that will further the effectiveness of API implementation. A few companies have developed API tools, such as Sansoro Health’s Emissary®, designed to support EHR and other HIT system interoperability.
It would be a mistake to see overwhelming EHR adoption as the best evidence of a mature technology. That’s because EHRs are complex systems that bring together a host of disparate resources for health data aggregation, storage, management, dissemination and sharing via what is hoped to be an intuitive UI. Just as these aspects are evolving, so too must the ability to deliver true interoperability so that providers can achieve optimum care outcomes in an increasingly complex and data-intensive health continuum.