In today’s digital age, when we are witnessing an instant exchange of information round the clock, healthcare providers are still struggling to share a patient’s health records with relevant stakeholders. Although the $35 billion incentive offered to physicians as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act in order to promote EHR adoption has led to an increased use of EHR by physicians, the rate of interoperability achieved by EHR software has remained remarkably low. By 2015, only 6% of healthcare providers could share patient data with other clinicians who use an EHR system different from their own. This significantly limits the efficiency that EHR systems were supposed to offer.
WHY IS INTEROPERABILITY SO HARD?
Firstly, there is an utter lack of standardization across the available EHR software. Hundreds of government-certified EHR products are in use across the country, each with different clinical terminologies and functional capabilities. These differences make it difficult to create one standard interoperability format for sharing data. Secondly, incentives initially offered by the government also focus on boosting EHR adoption instead of Health Information Exchange. Thirdly, the costs incurred by providers in order to integrate the interoperability feature in their EHR systems are too high and not sufficiently covered by the government incentives.
And lastly, interoperability itself is a complex concept. For two EHR systems to be truly interoperable, they must be able to exchange and then use the data. For this to occur, the message transmitted must contain standardized coded data so that the receiving system can interpret it. However, lack of standardized data is an issue that has plagued the U.S. health care system for decades and now certainly limits the ability to share data electronically for patient care.
INTEROPERABILITY – A CULTURAL CHALLENGE
Interoperability in healthcare requires the collaboration of various stakeholders, including patients, providers, software vendors, legislators, and health information technology (IT) professionals. Yet the U.S. health care delivery system continues to be disjointed, where data have become more of a commodity and competitive advantage than a basis for coordinated care. Both the EHR vendors and the providers deliberately interfere with the flow of information between different EHR systems in an attempt to maintain their market dominance. Even those EHR vendors that do offer interoperability, do so at exorbitant costs. These software developers charge up to $50,000 for EHR interfaces to connect to blood and pathology laboratories, hospitals, pharmacies, and other providers.
To tackle this problem, at the end of 2016, a 21st Century Cures Act was passed, under which penalties of up to $1 million were assigned to software developers, networks, and providers who engage in information blockage practices. American Medical Association (AMA) is also working on a number of fronts with the EHR vendor community and other stakeholders to improve the usability and interoperability of these products.
MEANINGFUL USE – BURDEN TO PHYSICIANS
While a well-designed EHR provides many benefits to both the clinical practices and their patients, physicians have felt burdened by both the technology and meaningful use regulations. A recent study found that for every hour of clinical work, physicians spent two hours on clerical or EHR-related tasks.
While the meaningful use program rewarded providers for adopting and demonstrating meaningful use of EHR systems, it also penalized those who failed to do either. The EHR vendors, thus, focus more on government reporting requirements, largely ignoring the needs of physicians and patients. This has led to physician burnout in almost half of the US physicians today.
In April 2016, in order to deal with this issue, CMS (Centers for Medicare and Medicaid Services) proposed easing some requirements for physicians under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This was hailed as a positive step by medical societies and state associations.
EHR ADOPTION COSTS – A BARRIER
Despite the potential for incentive payments, the financial costs of implementing EHRs remain a primary barrier to their adoption, especially in rural hospitals or smaller practices. Many physicians are opting out of all or part of the meaningful use program. The average family physician, who receives about $100,000 annually, could lose up to $10,000 in Medicare reimbursements by 2018. But for some physicians, the penalty is a small price to pay for not having to deal with requirements that they feel prevent them from delivering better patient care.
THE PATH TO EHR INTEROPERABILITY
Whether it’s a solo practice, a rural hospital, or a massive health system, EHR interoperability is a huge, complex, and ongoing undertaking in health care delivery, involving the interplay of a range of stakeholders both within and across care settings. And while physicians, hospital administrators, and other stakeholders in the healthcare community seem to support interoperability—believing it will improve patient care, reduce medical errors, and lower costs—it has yet to become a reality for most of them.
In its October 2015 report, the ONC predicted it would be 2021 to 2024 before the nation’s health system achieves interoperability. But for this to happen, many barriers will need to be addressed, including physician dissatisfaction with EHRs, overregulation, and cost. The government will need to provide stronger incentives to both providers and EHR vendors to promote interoperability. And all healthcare stakeholders will need to be a part of the interoperability effort in order to break down health data silos and allow patient health information to be available across all settings of care.
With hundreds of EHRs in the market, it is hard to pick a certified system for your practice. Implementation, costs, hardware requirements, usability, and interoperability all come into play. MTBC’s EHRs have taken it all into consideration and offers an intuitive platform for your practice needs.