Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Data Exchange News

Electronic Health Data Exchange Eludes Small, Rural Hospitals

A recent ONC data brief on hospital interoperability found small, rural, and critical access hospitals to have significantly lower levels of health data exchange and healthcare interoperability.

- Compared to larger urban and suburban hospitals, small, rural, and critical access hospitals reported lower rates for sending, receiving, finding, and integrating data electronically, according to new data published by the Office of the National Coordinator for Health Information Technology (ONC).

Health data exchange among US hospitals

For hospitals with all four domains, medium-to-large (34%), non-rural (34%), non-critical (30%) hospitals (34%) outperformed their counterparts by a margin of two to one: small (18%) critical access (17%), and rural (15%) hospitals.

The data come from a 2014-2015 annual survey on health IT by the American Hospital Association.

Despite the variation in hospital health data exchange and healthcare interoperability, researchers report progress among non-federal acute care hospitals in their reduced use of  paper-only methods of health data exchange and increased use of mixed methods (both electronic and paper).

The implications for hospital interoperability are clear based on variation in the number of hospitals capable of supporting electronic health data exchange, the researchers wrote.

"As hospitals transition to electronic means of sending and receiving summary of care records, they may still have to rely on paper-based methods to exchange information due to their exchange partners’ limited capability to electronically receive information; this was the most common barrier to interoperability reported by hospitals," state Patel et al.

Small, rural, and critical access hospitals struggle with electronic health data exchange.

Juxtaposed to the average non-federal acute care hospitals, small, critical access, and rural hospitals lagged behind in their access to external health data electronically, which means more often than not providers practicing in these locations lack a comprehensive view of their patients' health.

Small, rural, and critical access hospitals often lack a full view of a patient's history of health

Between 2014 and 2015, hospital use of only non-electronic health information exchange decreased for both sending and receiving summary of care records (a meaningful use requirement) — 26 percent and 17 percent for the former, 14 percent to 7 percent for the latter.

At the same time, mixed means for sending and receiving summary of care records rose by 8 percentage points for the former and 7 percentage points for the latter. Meanwhile, electronic-only health data exchange remained the same: 7 percent and 9 percent, respectively.

As for the electronic mechanism used to exchange health data, EHR secure messaging led the way as a means of sending for 76 percent of respondents as well as for receiving data for 54 percent of responding hospitals.

The next most-common means of electronic health data exchange was the use of an health information organization (HIO) or third party (60% send; 45% receive), followed by the use of a provider portal (48% send; 30% receive).

Strictly on the subject of HIE participation, six in ten hospitals connected to either a state, regional, or local HIE and relied on HIE vendors to facilitate the exchange of health information. Close to two-thirds of hospitals (61%) used an HIE vendor and participated in an HIO. Half that number (31%) reported using an HIE vendor but not participating in an HIO.

The researchers also found notable increases in the rates of sending and receiving summary of care records between hospitals and other provider types.

For receiving this health data, outside hospitals and ambulatory providers were the most common senders — 40 percent and 37 percent respectively. Also featuring prominently were long-term care and behavioral health providers, both at 23 percent.

The digital divide between primary and specialty care emerged in the area of electronic sending summary of care documents. Outside ambulatory and hospitals were the most common recipients — 61 percent and 59 percent respectively. Long-term care providers fared fairly well at 49 percent, but little more than a third of behavioral providers were sent this health data.

In a post on HealthITBuzz accompanying the release of the data brief, ONC Principal Deputy National Coordinator Vindell Washington, MD, explained that improvements to health data exchange and interoperability among small, rural, and critical access hospitals are at the forefront of the federal agency's efforts to create a learning health system:

In particular, we are focusing on increasing access to financing for everything from brick-and-mortar infrastructure to software and broadband connectivity. For example, on behalf of the White House Rural Council, the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA) have been leading a Collaborative Rural Health Financing initiative to link health care providers serving rural, poor and tribal communities, as well as communities with large populations of rural veterans, with financing necessary for facility upgrades, telehealth and health information exchange. Between 2012 and 2014, this HHS and USDA led initiative generated approximately $1 billion in rural health care financing across 13 states.  As of May 2016, we have expanded this initiative to 18 states.

ONC is also partnering with the FCC and other commissions and agencies to address broadband connectivity challenges limiting the use of telehealth and health information exchange. 

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