Health information exchange barriers hamper telehealth adoption

Telehealth visits at United States hospitals skyrocketed during the COVID-19 pandemic, rising 75 percent between 2017 and 2021; however, adoption was uneven, with hospitals citing challenges to electronic health information exchange, according to a new study.

Published in the Journal of General Internal Medicine, the study examined US hospitals’ adoption of telehealth before and during the pandemic, aiming to provide targeted policy implications.

The research team, led by Michigan State University researchers, conducted a cross-sectional study leveraging data from the American Hospital Association's (AHA) annual surveys from 2017 to 2021 and the 2022 AHA IT Supplement Survey. They studied the number of telehealth encounters, the percentage of hospitals offering telehealth services, and institutional challenges to electronic health information exchange.

The researchers found that telehealth encounters increased from 111.4 million in 2020 to 194.4 million in 2021, a 75 percent jump. Additionally, hospitals offering at least one form of telehealth increased from 46 percent in 2017 to 72 percent in 2021.

However, the adoption was not uniform across hospitals. Larger, nonprofit, and teaching hospitals were more likely to adopt telehealth than their counterparts. Notably, the study found no significant telehealth adoption disparities between hospitals in urban and rural areas.

Further, more than 90 percent of hospitals allowed patients to view and download medical records, but only 41 percent permitted online data submission. One-quarter (25 percent) of hospitals identified certified health IT developers, such as EHR vendors, as frequent culprits in information blocking.

Most US hospitals also reported challenges in exchanging health information electronically, with 85 percent citing barriers related to vendor interoperability.

The researchers concluded that comprehensive policy interventions are necessary to address telehealth adoption and other IT-related disparities across the US healthcare system.

“As we look to the future of health care, it’s clear that telemedicine will play an increasingly vital role. Our study not only highlights the progress we’ve made but also serves as a call to action,” said study lead author John (Xuefeng) Jiang, Eli Broad endowed professor of accounting and information systems at Michigan State University, in a news release. “By addressing the disparities in adoption and overcoming technical barriers, we can create a more accessible, efficient and patient-centered health care system. The rapid growth we’ve observed shows the potential; now it’s time to ensure that all patients and health care providers can fully benefit from these technological advancements.”

The study findings add to our understanding of telehealth adoption during the pandemic, which is critical information for lawmakers shaping telehealth policy beyond 2024.

Currently, telehealth flexibilities enacted during the pandemic are set to expire on December 31, 2024. These include eliminating geographic restrictions on originating sites for telehealth services, waiving the initial in-person care requirements for those receiving mental healthcare through telehealth, and allowing for continued coverage of audio-only telehealth services.

Telehealth proponents have been advocating for making these flexibilities permanent. In a hearing conducted by the House Energy and Commerce Committee’s Subcommittee on Health in April, clinicians and patients noted the benefits of telehealth and expressed support for legislation that bolsters virtual care access.

For example, Eve Cunningham, MD, group vice president and chief of virtual care and digital health at Providence, said telehealth has become integral to the care delivery system, boosting care quality, access, and patient satisfaction and mitigating workforce burnout and hospital capacity challenges.

Other stakeholders highlighted the barriers that need to be eliminated to allow Americans from various backgrounds to reap the benefits of telehealth. Lee Schwamm, MD, senior vice president and chief digital health officer at Yale New Haven Health System, emphasized the importance of efforts to close the digital divide and noted that payment permanency is required to make these efforts a reality.

In light of the challenges to ensuring equitable access to telehealth, Congress appears to be considering extending telehealth flexibilities through 2026 rather than making them permanent.