Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Infrastructure News

Health IT Infrastructure, Costs Hinder Health Data Exchange

- Findings from a new interoperability survey conducted by the Workgroup for Electronic Data Interchange (WEDI) reveal the challenges facing healthcare organizations and providers working to improve health data exchange.

The results are part of the organization's feedback on the nationwide interoperability roadmap drafted by the Office of the National Coordinator for Health Information Technology (ONC) earlier this year and gauge the healthcare IT status of industry stakeholders, with the largest number of respondents (163 of 376) being health providers.

One of the major findings from the WEDI survey is the limited ability of healthcare providers to exchange clinical information electronically with non-affiliated healthcare organizations.

"When reviewing all respondent provider types combined, the exchange for both sending and receiving is primarily medium to difficult," WEDI Chair Jean Narcisi writes in a letter to National Coordinator Karen DeSalvo, MD, MPH, MSc. "Some variance was seen in the exchange with laboratories, in that there was an even amount indicating receiving data was easy, medium or difficult."

The most difficult forms of clinical information exchange occurs when sending data to long-term and post-acute care providers, with 44 percent indicating high levels of difficulty. Hospitals or health systems were the second most-difficult category of recipients at 30 percent. Conversely, respondents indicated low levels of difficult sending clinical information electronically to pharmacies (35%).

Challenges of health data exchange for sending information

As for the challenge of receiving information from non-affiliated healthcare organizations, respondents indicated that long-term and post-acute care providers (51%), patients and caregivers (38%), and hospital or health systems (36%) as the top-three most difficult. Laboratories were the easiest to receive information from but only a quarter of respondents indicated so.

Challenges of health data exchange for receiving information

When this out-of-network health data exchange does occur, it most likely occurs through the use of Direct secure messaging or end-to-end integration and interfaces that enable information to be pushed — 33 percent and 30 percent, respectively, exchange health information electronically with non-affiliated organizations routinely these ways. Centralized queries using centralized repositories were never used by 43 percent of healthcare provider respondents, ten percentage points higher than distributed queries using independently hosted systems.

Health data exchange capabilities used by healthcare providers

Integration and blending structured and unstructured data presented the greatest difficulty for healthcare providers when performing data activities related to interoperability. Forty-two percent reported that the integration of different types of electronic data (e.g., administrative, claims, patient-generated) and structures were difficult activities — even for integrated delivery systems (IDS).

Health data exchange difficulty based on data activity

"We anticipate this might shift somewhat as the industry moves toward Meaningful Use Stage 3 incentives and EHR certification programs as well as Administrative Simplification Health Claim Attachments in the coming years," the WEDI report states.

Unsurprisingly, the costs of making electronic health systems interoperate prove to be a significant barrier moving forward for healthcare providers. One third or more respondents indicated that infrastructure costs (35%), connection and setup fees (33%), and training of staff (33%) were significantly challenging form a financial perspective.

Health data exchange financial barriers for providers

Meanwhile at the level of challenging, ongoing transactional fees for exchanging data and ongoing memberships for participating in a health information exchange (HIE) network led the way as financial obstacles:

Financial challenges are likely to be a significant barrier to the electronic exchange of health information, especially with less than 10 percent of providers indicating costs are not challenge at all. Independent practice associations indicated costs are a significant challenge for all potential barriers while LTPAC providers indicated costs are a significant challenge for infrastructure and staff training and challenging for connection and set‐up fees.

No matter the interoperability challenges facing healthcare providers, a majority of respondents agree that improvements in health data exchange will lead to improvements in numerous areas (e.g., care coordination, quality, provider satisfaction), all of which bodes well for garnering provider support of interoperability initiatives.

"Provider openness to improving interoperability is key to the success of efforts to achieve greater exchange of electronic health information," the WEDI letter to the ONC states.

Image Credits: WEDI

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