Health Data Exchange Barriers Impede Widespread Interoperability

Widespread interoperability among office-based physicians is lacking due to a number of health data exchange barriers, according to a recent ONC Data Brief.

The report used 2019 CDC National Electronic Health Record Survey data to evaluate health data exchange and interoperability between office-based physicians across the nation. This is the most recent year for which ONC has complete data.

In 2019, nearly 65 percent of office-based physicians engaged in some form of electronic health data exchange, whether that be sending, receiving, or querying health information, ONC researchers found.

Among physicians who engaged in health information exchange (HIE), 85 percent reported barriers regarding HIE between providers who use a different EHR system.

Seventy-three percent of physicians reported that HIE involving multiple systems or portals was a barrier to exchange.

In addition, 71 percent noticed that providers in referral networks lacked the capability to exchange data due to gaps in the use of interoperable technology.

“These barriers highlight the potentially high cost, complexity, and burden involved in widespread information exchange in the current environment,” ONC researchers stated.

On the other hand, participating in HIE led to better care quality and care coordination for more than 80 percent of providers.

Providers who engaged in HIE also observed fewer unnecessary duplicate test orders. In the United States, nearly $65 billion is spent per year on laboratory testing, of which 20 percent to 30 percent of all testing is unintentional.

Even though engagement in some form of electronic health data exchange was high, only 10 percent of physicians reported engaging in all four measured interoperability domain such as such as finding, sending, receiving, and integrating patient data.

While interoperability was relatively constant between 2015 and 2019, the number of physicians electronically finding or querying for patient information rose to 49 percent during that same period.

Meaningful progress has been made related to supporting query-based exchange. Yet, there needs to be more clinician engagement in the remaining interoperability domains to meet the needs associated with different use cases, the report highlighted.

“The increase is likely related to specific EHR developers offering capabilities to search for patient health information from within their network of users, as well as increased engagement in national networks that help facilitate query-based exchange,” the authors wrote. “Physicians’ engagement in the remaining dimensions of interoperability (sending, receiving, and integrating information) remained flat.”

Researchers did make out a divide in interoperability by practice size. Larger practices with more than 50 physicians engaged in all four domains of interoperability at nearly double the rate of physicians in practices with fewer than 50 physicians and at five times the rate of solo practitioners.

In addition, larger practices were twice as likely to have information available from outside sources and more than three times as likely to utilize the information than physicians in solo practices.

The findings also suggested that participation in CMS Promoting Interoperability or Medicaid EHR Incentive Programs was linked to an increase in HIE engagement and may promote interoperability.

“Our findings indicate that CMS policies and programs may also improve exchange across a number of areas,” the authors wrote. “For example, although only about one-quarter of primary care physicians electronically received ED notifications in 2019; this will likely increase with the implementation of a CMS policy, effective April 2021, which requires hospitals to send patient event notifications to primary care providers.”

“The high level of physician engagement in reconciliation of medications, allergies, and problem lists using data received from another provider may reflect the role CMS plays in incentivizing this activity as part of the MIPS Promoting Interoperability for practices with over 15 clinicians,” the authors continued.

ONC also said that principles based on the 21st Century Cures Act, such as the Trusted Exchange Framework and Common Agreement (TEFCA), will work to address exchange barriers regarding HIE across different EHR systems.

TEFCA may simplify exchange by allowing organizations to connect to multiple networks under one common umbrella regardless of physicians’ current EHR provider. This framework could also reduce the need to use various systems to exchange information.

“TEFCA may also help boost engagement in exchange among those who have not previously participated and thus help address gaps related to physicians’ exchange partners lacking the capability to exchange,” the authors mentioned.

ONC researchers said they look forward to measuring the impact initiatives have on interoperability.

“Measuring the impact of these initiatives on physicians’ experiences with interoperability will provide insight on our success in addressing specific barriers, reducing engagement gaps, and ultimately achieving the goal of widespread interoperability,” the authors stated.