Under ideal conditions, patients’ health information should seamlessly and electronically follow the patient across care settings, for instance - from a visit to the primary care physician, to the lab where tests are performed, to the hospital that the patient finally gets admitted to for a procedure. This continuity should not be limited to the patient’s interaction with multiple healthcare providers at different locations across the care continuum. The EHR systems adopted by these providers should ideally be able to connect the dots for each patient and allow an attending doctor at any point in time at any location to view full patient details right from the diagnosis, to lab results, to hospital procedures with the click of a button.
However today in the US, this level of interoperability remains a gap. In the previous example, if PCP, lab and hospital were part of the same network and were using a common EHR system, then, tracking patient longitudinally will be smooth. However, in most of the cases, these providers are using different EHR systems and these systems do not always interact with each other, hence, making it difficult to track patient’s health information across care settings. This has been compounded by recent consolidation with the provider systems. This consolidation has forced groups with different systems to integrate, causing intra-operability challenges and disrupting the ability follow patients longitudinally.
Beginning in 2009, adoption of EHR technology received a major push from CMS. A plan was laid out by CMS to incentivize healthcare providers for adopting and demonstrating meaningful use of EHRs. EHR adoption gained momentum in the next 5 years and adoption rates within hospitals and physician practices increased significantly. As of December 2015, 95% of the critical access hospitals participating in the CMS’ EHR incentive programs had adopted and demonstrated meaningful use of EHR.
While EHR systems successfully penetrated the healthcare landscape, it posed another challenge for its users, especially physicians, and that is Interoperability. EHR of one hospital (or a lab/practice) is not talking to the other and therefore physicians are not able to electronically access patient health records when needed. For instance, instead of being able to access patient records electronically from their offices, physicians, at times have to reach out to respective hospitals that patients have been to or are coming from. Primary care providers are in many cases either calling the hospital, faxing them or even worse, personally picking up patient details/records from the hospital.
ACOs, which focus on outcome based payments, have been substantially affected by this trend. ACOs by definition have to focus on better outcomes, improved quality and reduced costs. However, interoperability has emerged as a concern for them as well. While they could longitudinally see patient details within their network as all in-network care settings are using the same EHR system, they may not be able to do the same if patients go out of network for care. This makes it difficult for ACOs to intervene at the right time when the care is needed.
It is imperative that patients’ health records are electronically available to physicians and other healthcare providers whenever and wherever needed to ensure better coordinated care delivery. This will reduce inefficiencies within the care continuum and help reduce costs. The roadmap, shared by Office of the National Coordinator for Health Information Technology (ONC), has already laid out the long term plan for achieving nationwide interoperability by 2024. Looks like interoperability is poised to gain momentum in the coming years and patient health information sharing within healthcare providers will be seamless and would happen in real time as well.
- Office of the National Coordinator for Health Information Technology. 'Hospitals Participating in the CMS EHR Incentive Programs,' Health IT Quick-Stat #45. dashboard.healthit.gov/quickstats/pages/FIG-Hospitals-EHR-Incentive-Programs.php. February 2016.
- Shared Nationwide Interoperability Roadmap: The Journey to Better Health and Care