Billions Spent, Yet EHR Data Sharing Remains Elusive: Unpacking the Barriers

Although the vast majority of physicians now use certified electronic health records (EHRs), data sharing among clinicians remains relatively uncommon. A 2015 survey by the Commonwealth Fund, an international health policy organization, found that nearly 60% of U.S. primary care providers were unable to electronically exchange relevant summaries of patients’ clinical data with other clinicians.

In other words, most clinicians and their patients remain unaware of the potential benefits of clinical data sharing, which include improved care coordination between physicians and patients, reduced duplicate treatments, and a lower risk of medical errors.

One issue plaguing the healthcare industry is persistently high costs. Why is this the case? One factor influences the healthcare industry more than all others combined.

“The real culprit behind rising expenditures is technology,” wrote U.S. health economist Austin Frakt. “As you age each year, healthcare technologies also undergo corresponding changes—usually for the better, but always at a higher cost. Technological change accounts for at least one-third to two-thirds of the growth in per capita healthcare spending.”

It is important to clarify that Frakt is referring to all technologies, not just healthcare-related IT. In fact, while IT may account for a relatively small share of the total volume of existing medical technologies, it does concentrate on a larger group when considering the direct relationship between technology and cost.

Mark Mack wrote in a Government Finance Officers Association document: “The desire for innovation... appears to have created a new culture in which medical technologies are adopted prematurely, and new medical technologies are used for additional purposes beyond their original intent. In some cases, technologies offer only marginal improvements over existing treatments, yet come with significantly higher price tags.”

Medical IT, particularly Electronic Health Records (EHR), can generate alerts, ensure immediate access to records, facilitate faster communication, and streamline reporting processes. It also supports real-time billing and provides services that deliver life-saving best practices and cross-referenced data, all of which are significantly faster and more efficient than human cognition.All of these technologies will make healthcare more effective and safer.

However, how much are hospitals willing to pay for these safeguards? This is a difficult question to answer, given that some hospitals can afford to pay more, while others cannot.

If you are Kaiser Permanente or a partner, you would be willing to invest billions of dollars in researching this technology. However, as you move further down the hospital hierarchy, large organizations spending millions of dollars will encounter challenges in creating business and financial viability, leading to the reality that fewer and fewer institutions are willing to spend this money to continue research.

For example, in 2014, the chief financial officer of Becker’s Hospital Review reported that a hospital incurred an operating loss of $56 million in the previous fiscal year due to the purchase of an electronic health record (EHR) system, and Standard & Poor’s downgraded the credit rating of Wake Forest Baptist Medical Center. Last year, Becker also acknowledged a 56% decline in adjusted revenue associated with MD Anderson’s EHR implementation; shortly thereafter, seven other hospitals that implemented the same system similarly faced revenue shortfalls.

Perhaps we should ask how much hospitals need to spend to acquire sufficient technology to improve care.

For example, Pikeville Medical Center could provide a substantial number of EHRs. However, investing funds there would mean not allocating them to expanded services, so the hospital’s decision-makers opted for a comprehensive yet more affordable system.

Why should we care about whether health systems can afford this technology, rather than letting them spend billions of dollars on complex EHRs?VCBeat has learned that,Because medical costs do not exist in an organizational vacuum. Purchasing decisions like these drive healthcare expenditures across the entire system, which in turn affects societal progress.

U.S. healthcare spending now accounts for 17% of the national economy, double the level in 1980, and the medical care surge from the baby boom generation has yet to reach its peak. Furthermore, while these rising costs result from many factors, various healthcare technologies only exacerbate this trend rather than alleviate it.

But its development does not necessarily have to follow this path. Healthcare IT, particularly Electronic Health Records (EHR), offers a unique opportunity to help reduce costs through process improvements, but only if these systems do not mortgage the future and plunge hospitals into financial distress.

Even if the U.S. healthcare system has not entered a potentially vibrant historical period, threats to the Affordable Care Act could deprive more than 20 million insured patients of access to meaningful healthcare IT technologies. After all, this technology is currently driving the transition from fee-for-service payment models to value-based care.

According to VCBeat, over the past seven years, the United States has undergone a historic transformation in health information technology, shifting from a healthcare system primarily based on paper records to a society in which nearly every individual has a digital information footprint. Electronic Health Records (EHRs) are one of these innovations.

Recent data sharing has quantified how rapidly social technologies are transforming the current landscape of clinical care. Today, nearly all hospitals (96%) and a growing proportion of physicians (78%) have begun adopting certified electronic health records (EHRs). This shift is a result of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, at which time fewer than 10 out of every 100 hospitals used EHRs, while over 17% of physicians had already started using them.

The rapid adoption of this technology reflects the relentless efforts of clinicians and global health systems, while also helping to usher in a new era in medicine. As a result of these efforts, vast amounts of electronic health data are now far more utilizable than they were seven years ago.

This transformation is not merely a process of digitizing paper-based health records; it also represents a means for the United States to maintain its global competitive advantage and drive real-world change in clinical settings. Academic literature on systematic reviews has found that 84% of studies indicate that certified EHRs have a positive, or at least non-negative, impact on the quality, safety, and efficiency of care in hospitals. Meanwhile, recent research has further demonstrated that EHRs can reduce adverse events among patients with cardiovascular conditions, those undergoing surgery, and those with pneumonia.

These results reflect the vision we articulated last year in two key documents: the five-year plan for the 2015–2020 Federal Health Information Technology Strategic Plan, developed in collaboration with more than 35 federal partners, and the roadmap for achieving nationwide interoperability of health information, co-created with the private sector. The roadmap outlines milestones for this technology, calls to action, and commitments on which public and private stakeholders should focus to ensure continued progress, particularly in the near term.

These plans recognize,Adopting health information technology is merely the first step toward ensuring the seamless integration and secure transmission of health data. This is why, in addition to the impressive statistics, we are equally excited that in 2015, more than eight hospitals electronically exchanged laboratory results, radiology reports, clinical care summaries, or medication lists with outpatient care providers or hospitals outside their organizations.。

Under advanced exchange measures, approximately one in nine hospitals electronically send, receive, query, and integrate information, thereby acquiring and providing clinical information from external sources—roughly twice the national average.

These plans also reflect a shift in focus from the adoption of electronic health records (EHRs) to their role in improving patient experience and health outcomes.This focus more comprehensively and holistically reflects the use of federal payment, procurement, and policy levers to make electronic health information more accessible and usable across the entire care continuum.

Meanwhile, during this process, we also observed an increase in user satisfaction with EHR systems. In 2013, market research surveys revealed that nine out of more than ten multi-specialty groups expressed dissatisfaction with EHR products and developers. However, when this group conducted a follow-up survey in 2015, they found a dramatic reversal. Last year, 84% of vendors reported that their EHR systems met or exceeded their expectations. This is particularly significant because EHR usability has been closely linked to physician satisfaction. Furthermore, seven out of eight administrators believed that their practice management and the business or financial capabilities of their EHR software had improved.

Of course, we recognize that there is still much work to be done before we fully realize our vision of enabling all clinicians, hospitals, and individuals to achieve a truly seamless and secure flow of electronic health information. The Office of the National Coordinator for Health Information Technology (ONC), along with our public and private partners, has accelerated interoperability efforts, focusing on three key drivers of success:

Use common, federally recognized national standards;

Change the culture surrounding information access;

Build the business case for interoperability.

To achieve these goals, the administration is leveraging a powerful tool—delivery system reform—to advance the business case for interoperability; issuing new guidelines under the Health Insurance Portability and Accountability Act (HIPAA) to ensure healthcare providers and individuals are aware of patients’ rights to access and transmit their data; and requiring the release of application programming interfaces (APIs) to enhance connectivity between electronic health records (EHRs) and provider and consumer applications.

Earlier this year, Monmouth University conducted a survey to determine the most pressing issue as the United States undergoes a transition to new presidential leadership. Among all the potential challenges currently facing Americans, healthcare costs remain the most critical concern.

Healthcare costs have received excessive attention. More importantly, when asked open-ended questions such as, “Turning to issues closer to home, what is the biggest challenge your family is currently facing?” 25% of respondents considered this the first question they were asked during the interview.

Professor Patrick Murray of the politically independent Monmouth University Polling Institute stated, “It is worth noting that issues that have long dominated news coverage, such as immigration and national security, actually rank low on the list of Americans’ true concerns.”

We can see that overall healthcare costs last August rose higher than in any month since 1984.

However, all doctors still face an electronic data# Sharing the Major Challenges？ One reason is the technical difficulty of data exchange; furthermore, the inability to transmit these data to recipients in a meaningful format poses a significant challenge.. However, to truly understand the underlying context of this phenomenon, we must first examine why physicians need to share clinical information and how this objective can be achieved.

VCBeat has learned that, to facilitate the sharing of clinical data, clinicians need to extract information from other information providers while enhancing the capability for mutual information push among these providers.

If we examine how these healthcare providers have shared clinical data in recent years, it becomes evident that the process is far from efficient. For instance, emergency department physicians may need to contact the patient’s primary care provider and then fax relevant health history records—a highly time-consuming request. Subsequently, they must manually enter or scan these historical records into the hospital’s system.

Clinicians must also regularly forward these patient records to other healthcare providers. The referring physician may give the patient a stack of paper records to deliver to their new doctor, or fax the records directly. Similarly, the new healthcare provider must manually enter or scan the records into the EHR.

Clearly, this “backward” approach to extracting and analyzing information is highly inefficient.

When patients present to the Emergency Department (ED), healthcare providers often need to promptly obtain additional clinical information to gain a more comprehensive picture of the patient’s health status. If both the ED and primary care physicians have access to data-sharing services, the ED can directly utilize an electronic query system to identify where the patient has previously received medical care and request electronic downloads of the relevant records.

Currently, there are two different proposals. One is CommonWell, a team dedicated to promoting industry collaboration for nationwide health data exchange in China. The other, led by SureScripts, advocates the use of the National Record Locator Service (NRLS) to provide care teams with more comprehensive patient information.

By providing interfaces and a master patient index, these two initiatives aim to make it easier for healthcare providers to query patient information from disparate sources, including electronic health records (EHRs), rather than seeking to establish point-to-point connections between every system immediately., but we should see rapid development in these two projects within the next two years.

Alternatively, when a patient is transferred from one physician to another, the new physician can securely forward the patient’s medical records online via Direct messaging. Direct messaging is a standardized protocol for exchanging clinical messages and attachments, and in certain strictly defined workflows, EHR systems possess Direct messaging capabilities for authentication purposes.

Most clinicians have already acquired the technologies that facilitate data exchange with other physicians. However, until more clinicians adopt these technologies in earnest, electronic data sharing will not become ubiquitous.。

Why do clinicians adopt related technologies to share data electronically? Is it because they are reluctant to use such technology, or because there are too few healthcare providers in their workflow to enable electronic data sharing?

First, we consider physicians with relevant needs who use direct messaging to share records with other healthcare provider groups.

To share records, both the sending and receiving clinicians must use “Direct Messaging.” If either clinician is not a user of “Direct Messaging,” these medical records must be sent via fax or on paper. Therefore, even if some physicians have access to the “Direct Messaging” feature, they may abandon the technology if other providers choose not to use Direct.

CMS has long encouraged the electronic transmission of patient data, aiming to resolve this chicken-and-egg dilemma by continuously lowering data-sharing requirements. For instance, although the “Direct” project was launched in 2010, 2016 marked the first year that healthcare providers were required to use “Direct” to meet the objectives of the EHR Incentive Program.

Electronic data sharing is a requirement for the vast majority of clinicians, yet some health systems and health IT vendors continue to obstruct data sharing in order to protect their own interests.. Ultimately, if we wish to achieve widespread adoption of these technologies, mandatory data sharing must be enforced.

Meanwhile, we need to improve technology to deliver real value to these healthcare providers. Clinicians using certified EHRs have the information delivery capabilities they require. However, the format of transmitted records needs further simplification to enable physicians to easily identify patient-specific relevant issues. At the same time, we must be able to eliminate extraneous and invalid information to optimize the care process.

We also need greater efforts from both the private and public sectors to standardize this data-sharing process. Governments should encourage data sharing while establishing relevant standards to ensure that appropriate testing makes the entire sharing process more efficient and transparent.

The development of standards can be an overwhelming task, and we must be careful not to attempt to address every possible issue that may arise., on the contrary, we should start with simple and common cases to meet the needs of a large number of healthcare providers, and then build additional cases over time.

The emergence of various technological initiatives and government incentive programs has demonstrated the feasibility of electronic sharing of patient data among healthcare providers. Current achievements represent only early successes in this endeavor; addressing policy changes and leveraging technological advancements are essential to further scale and promote this technology.

This article is sourced from http://hitconsultant.net and translated by VCBeat.