50% Patient Data Matching Error Rate Highlights Five Major Challenges in Seamless Healthcare Data Interoperability

Improving healthcare interoperability was a top priority in 2017 for healthcare providers, policymakers, and patients alike. The ideal state involves mobilizing the entire industry to achieve seamless data exchange across multiple health IT systems, thereby facilitating collaborative care across different points of healthcare delivery.

Over the years, proposed solutions for healthcare interoperability, medical data exchange frameworks, and healthcare IT standards have significantly improved the efficiency of information exchange.

However, achieving true interoperability still requires overcoming several hurdles. In this article, VCBeat (WeChat: vcbeat) outlines the five biggest challenges to achieving interoperability.

For nearly two decades, organizations such as HIMSS have been striving to promote the adoption of a national patient identifier. Assigning a unique identifier to each patient helps ensure that hospitals exchange medical information and patient health records efficiently and accurately. Mismatched electronic health records (EHRs) can lead to errors in patient care, increasing the risk of patient harm.

Senior Analyst Amy Tsou believes that the incorrect matching of patient information is mainly due to three reasons: insufficient staff training, lack of patient photo ID verification, and absence of standard operating procedures for record identification codes or reporting violations.

Although efforts to create a national patient identifier have somewhat stalled in recent years, recent policy developments and emerging initiatives indicate that healthcare IT innovation is poised for progress in the near future.

Not long ago, the Regenstrief Institute announced that the company wouldDeveloping a Solution for Automated Patient Electronic Medical Record (EMR) System Matching。

The Center for Biomedical Informatics (CBMI) at the Regenstrief Institute is dedicated to developing and testingEvidence-Based Solutions, thereby improving the accuracy of patient matching and reducing patient harm caused by erroneous identification of health records. The research project was funded with a total of $1.7 million provided by the U.S. Agency for Healthcare Research and Quality (AHRQ).

As expected, within five years, the Regenstrief Center for Biomedical Informatics will be able to leverage the resources of the Indiana Patient Care Network (INPC)—the largest clinical data center in the United States—to design realistic, evidence-based solutions that enhance patient matching capabilities.

Shaun Grannis, Director of CBMI, stated, “Accurately linking patients with their health data is critical to their medical care. Data show that even within the same healthcare system, as many as one in five patient records are mismatched.”When data is transferred between different healthcare systems, the error rate for patient record matching reaches as high as 50%.。”

The U.S. Office of the National Coordinator for Health Information Technology (ONC), a federal agency, is also engaged in efforts to promote the nationwide adoption of a unique patient identifier.

In June this year, the U.S. Office of the National Coordinator for Health Information Technology launched the “Patient Matching Algorithm Challenge” to promote the development of emerging patient matching algorithms and increase transparency regarding the efficacy of patient matching methods.

From an interoperability perspective, the ability to perform patient matching at scale, efficiently and accurately, has always been a cornerstone of national health IT infrastructure.

Regardless of the objective,Patient matching is almost always essential to enabling interoperability of health data.. Patient matching also requires careful consideration of its impact on patient safety and administrative costs. The involvement of federal government agencies in the development of patient matching algorithms is a direct result of recent legislative changes.

Not only that, after nearly 20 years of advocacy by CHIME and HIMSS, the U.S. Congress has finally clarified the extent of federal restrictions imposed by the UPI ban on civilian organizations developing a national patient identifier.

“UPI is no longer a reliable solution capable of meeting this challenge,” said Carla Smith, Executive Vice President of HIMSS, in a recent statement. “Instead, the focus has shifted to patient data matching and the need for a nationally coordinated strategy spanning both the public and private healthcare sectors.”

With the introduction of new reporting language in legislation, the public sector is now able to provide technical assistance to the private sector, promoting innovation in China’s national patient identification system.

Despite widespread consensus on the importance of healthcare IT standardization, interpretations and implementations of these standards vary across healthcare organizations.

Kashif Rathore, Deputy Director of Interoperability at Cerner, believes thatFragmented Interoperability Standards Are Among the Greatest Challenges to Improving Interoperability Today。

Rathore stated in an interview, “What we need to remind ourselves is that healthcare delivery occurs across many different settings. Patients may be at home, in long-term care facilities, or in hospice hospitals. This is the ecosystem in which we now live. Therefore,”We need to pay attention not only to hospital consultation rooms but also to other potential healthcare settings.。”

The absence of interoperability standards, or poor enforcement of existing ones, complicates transactions and creates additional barriers to information flow, thereby hindering the seamless exchange of health data. “In certain areas, we lack interoperability standards,” said Rathore. “In many scenarios, standards are neither implemented nor followed, making data exchange difficult. This remains a limiting factor.”

However, Rathore believes that the CommonWell Health Alliance is Cerner’s solution to this issue. “The CommonWell Health Alliance is the network we use to promote interoperability on a national level in China. For national standards and national connectivity, this is the network we rely on.”

Solutions such as CommonWell facilitate health data exchange across organizations by providing interoperability services that leverage only the software already embedded in healthcare providers’ electronic health record (EHR) systems. The expanding alliance of healthcare organizations dedicated to promoting data exchange and standardization helps address the lack of uniform standards in healthcare delivery.

Metrics for interoperability vary in scale among different stakeholders. This April, the Office of the National Coordinator for Health Information Technology (ONC) proposed a potential solution to this issue: the “Interoperability Standards Measurement Framework.” This framework is designed to assess the industry’s progress in implementing interoperability standards and to evaluate how these standards are used to measure improvements in interoperability. Furthermore, enhanced measurement metrics will help track progress at the national level.

The proposed framework requires health IT vendors to report the percentage of end users utilizing specific standards, transaction volumes by standard, and the consistency and customization standards implemented. By implementing consistent standard measurement methods nationwide, the ONC can prevent health IT developers, healthcare organizations, and Health Information Exchanges (HIEs) from using disparate standards.

ONC stated at a press conference earlier this year that federal government agencies plan to enhance interoperability in the coming months.

According to Genevieve Morris, Principal Deputy National Coordinator for Health IT at the Office of the National Coordinator for Health Information Technology (ONC), one way for federal agencies to enhance interoperability is to implement the objectives outlined in the 2015 ONC Interoperability Blueprint. “We need to build strategies around those four goals, but we must ensure that we are identifying items from this blueprint that have not yet been achieved and still need to be accomplished, so that we can move forward,” Morris stated.

A fundamental objective of the ONC Blueprint is to coordinate stakeholders, develop industry-wide consistent policies, and revisit those policies that hinder interoperability.

To achieve this goal, multi-stakeholder meetings were convened this summer. These meetings aimed to develop a national plan for standardizing health data exchange through an exchange framework and common agreements supported by the 21st Century Cures Act. More than 500 stakeholders participated in the meetings, including National Coordinator Don Rucker.

The seminar experts emphasized that inSeamless health data exchange, improved population health management, and the need for advancements in competitive and open application programming interfaces (APIs) to encourage innovation by developers in these areas。

Over the coming months, stakeholders will collaborate to develop policies and standards in accordance with the priorities outlined at the July 24 meeting. These efforts are aimed at advancing the objectives set forth in the 2015 ONC Interoperability Blueprint, ensuring that all stakeholders pursue consistent progress in interoperability policy.

Although the U.S. Congress considers information blocking illegal, it remains a prevalent issue in health data exchange. A study released earlier this year surveyed 60 HIE leaders and found thatInformation blockades remain widespread., and policies aimed at curbing this practice have in fact yielded little effect.

The study conducted by Adler Milstein et al. also found that 50% of respondents admitted to collaborating with medical IT companies engaged in information blocking, and one-quarter of respondents acknowledged thatHospitals and healthcare systems bear responsibility for this matter.。

“In hospitals and healthcare systems, the most common form is forcing healthcare providers to adopt a specific EHR or HIE technology,” Adler Milstein wrote. For for-profit electronic health record vendors, it is a natural vested interest to achieve revenue growth by restricting data flow.

Adler Milstein and Pfeifer explained, “It is difficult for us to clearly determine which specific forms and motivations of information blocking are more prevalent.”We found that electronic health record (EHR) vendors most frequently engage in information blocking practices that directly maximize short-term profits.“Surveys of respondents indicate that electronic health record (EHR) vendors offer products with limited interoperability, which are then sold to healthcare providers at premium prices, or they explicitly state that they do not support information exchange with certain EHR systems or health information exchange platforms.”

Hospitals and healthcare systems also employ information blocking toPreventing Patients from Seeking Care Elsewhere, thereby maintaining its competitiveness.

Moreover, EHR vendors implementing information blocking may collude with hospitals to further enhance their competitive advantage, thereby perpetuating the cycle of information blocking and profiting from it.

Nevertheless, initiatives to combat information blocking are already underway. “Current efforts and legislative proposals by the ONC in the U.S. Congress are aimed at empowering the OIG to investigate information blocking and establishing relevant deterrents,” the researchers summarized. “If successful, the reduction in information blocking will help usEnsure that data flows with the patient across various healthcare provider organizations., which is crucial for improving the quality and effectiveness of medical care.”

Furthermore, although information blockades have not yet been completely eradicated, existing policies have already achieved some successes.

“Increasing transparency in the business practices and product performance of electronic health record (EHR) system vendors, stronger financial incentives for healthcare providers to share information, and the criminalization of information blocking are considered the most effective policy remedies,” the researchers wrote.

Kashif Rathore, Deputy Director of Interoperability at Werner, believes that fostering collaboration among healthcare IT companies, hospitals, and Health Information Exchanges (HIEs) can further hinder information blocking. He observed, “We often encounter situations where healthcare organizations and other vendors may consider this data as their own asset, potentially useful for competitive advantage in the future. This mindset is incorrect and does not benefit patients.”

He stated, “From the patient’s perspective, we need to facilitate information exchange and refrain from clinging to these data under the misconception that ‘this is my record.’ This is not ‘my’ record; it is the patient’s record.”

“Interoperability should be a public utility, notAny tool used by an individual to gain a competitive advantage.” Through collaboration, healthcare IT companies can move beyond health data exchange and begin to focus on addressing larger issues and initiatives.

Rathore believes that,If the financial sector and other industries can find solutions to consumer identification and cross-system transaction management issues, then the healthcare industry can do the same.。

Developing a nationwide patient identification code, enhancing standardization and collaboration across the industry, and breaking down information silos are all obstacles and challenges to achieving true interoperability. However, as solutions to overcome these challenges gain increasing traction, interoperability is likely to surpass these barriers and continue to improve.

References:

https://ehrintelligence.com/news/top-5-challenges-to-achieving-healthcare-interoperability

 https://ehrintelligence.com/news/researchers-discuss-problems-solutions-to-patient-identification

 https://ehrintelligence.com/news/regenstrief-to-develop-automated-patient-ehr-matching-solution

 https://ehrintelligence.com/news/health-information-exchanges-report-information-blocking

 https://ehrintelligence.com/news/standardization-collaboration-drive-interoperability-at-cerner