By Christine Kern, contributing writer
The advancement of HIT-related initiatives has been slow despite “considerable investments.”
The electronic sharing of information (health information exchange) plays a critical role in improving the cost, quality, and patient experience of healthcare. However, there is very little electronic information sharing among clinicians, hospitals, and other providers despite more than $24 billion in incentive payments to hospitals and eligible professionals who "meaningfully use" electronic health records, and another $2 billion spent on interoperability standards and EHR certification over the past five years.
This according to a health policy brief written by Janet Marchibroda, director of the Health Innovation Initiative at the Bipartisan Policy Center published by Health Affairs and supported by the Robert Wood Johnson Foundation.
Marchibroda explains, “While considerable investments in health IT have been made, advancement of interoperability and electronic information sharing across systems has been slow,” and “Additional action is needed to provide the information foundation necessary for higher-quality, more cost-effective, patient-centered care in the United States.”
Because most payment in the U.S. healthcare system today is volume based versus outcomes or value based, “there is little financial incentive to share information across settings to reduce costs or improve the quality of care.” Although new care models are expected to expand the business case for interoperability and information sharing, Marchibroda reports “so far these new models of care have relied upon old models of information sharing, including the use of phone, fax, or mail, or siloed information-sharing networks.”
The major obstacles to electronic sharing of information include the lack of a business case, the financial cost associated with exchange, a lack of standards adoption and interoperability of systems, continued concerns about privacy and security, and concerns about liability.
A study published by Health Affairs found that, of physicians surveyed in 2013, only 14 percent electronically sharing data with providers outside of their organizations. Meanwhile, a 2012 study published by Health Affairs indicates 51 percent of hospitals surveyed were sharing information with ambulatory care providers outside of their organizations, while 36 percent were sharing information with other hospitals outside of their organizations. And, another study cited by the brief revealed only 10 percent of ambulatory practices and 30 percent of hospitals were found to be participating in operational health information exchange efforts.
“In order to achieve electronic information sharing, EHRs and other clinical software must be ‘interoperable’ or have the capability to exchange information using agreed-upon standards, and those providing care and services must be willing to share information,” Marchibroda argues. Yet, to date, the requirements for both interoperability and electronic information sharing under the HITECH Act to date have been “fairly limited,” and Marchibroda specifically references Stage 1 of the meaningful use program.
“Stage 1 made it optional for providers transferring a patient to the care of another provider to furnish that provider with a summary of care record 50 percent of the time, and noted that such information need not be transmitted electronically,” she states.
Marchibroda does describe Stage 2 MU requirements as “more robust” and sees Stage 3 as a “significant opportunity to advance the interoperability of EHR technology and electronic information sharing among providers.”
Ultimately, the study concludes, “Additional action is needed to provide the information foundation necessary for higher-quality, more cost-effective, patient-centered care in the United States.”