Most Hospitals Exchange Data, But Scope Too Limited
ONC study suggests ways that providers could increase data interchange.
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Nearly six in 10 hospitals (58%) exchanged electronic health information with hospitals and other providers outside their organization in 2012, an increase of 41% since 2008, according to a Health Affairs study by researchers from the Office of the National Coordinator for Health IT (ONC).
EHR adoption and participation in health information organizations (HIOs, also known as HIEs) were associated with the increase in data exchange activities. However, exchanges of clinical care summaries and medication lists, both considered necessary for care coordination, remained limited.
The researchers analyzed data from an IT supplement to the annual American Hospital Association survey. This data represented a large sample of hospitals -- more than 2,800 in both 2008 and 2012 -- but did not provide answers to some key questions. For example, it was unclear whether hospitals were exchanging data through HIOs or some other mechanism.
Another recent study found that about 30% of hospitals and 10% of ambulatory practices now belong to public HIOs that transmit information across organizational boundaries. But lead author Julia Adler-Milstein told InformationWeek Healthcare that because some private HIOs include providers not affiliated with the HIO sponsors, it's possible that greater percentages of hospitals and doctors are exchanging information through HIOs.
The authors of the ONC study pointed out that their results include all information exchange activities, whether or not they involved an HIO. More than half of the hospitals responding to the survey exchanged lab results or radiology reports, the study noted, but only a third exchanged clinical summaries or medication lists with outside providers.
The type of providers that exchanged information was also revealing. Although half of hospitals exchanged data with unaffiliated physicians, only 36% exchanged data with other hospitals outside of their organizations. One hypothesis advanced in the study and supported by other data is that competing hospitals are reluctant to share information with each other.
The study also looked at the relationship between adoption of what ONC defines as a "basic EHR" and the likelihood and extent of health information exchange. In 2012, it said, 44% of hospitals had a basic EHR (compared to 9% in 2008) and 29% belonged to a regional HIO (compared to 16% in 2008).
Hospitals with basic EHRs that participated in an HIO -- of which there were five times as many in 2012 as in 2008 -- had the highest rates of information exchange activities. Eighty-four percent of those facilities exchanged data with outside providers, versus 71% of hospitals with HIO participation but no EHR and 60% of those with an EHR but no HIO participation. The 43% of hospitals in the survey that had less than a basic EHR and did not participate in an HIO were also the least likely to exchange information with other providers.
Hospitals that belonged to HIOs were more apt to exchange information than those that didn't, whether or not they had a basic EHR. The authors speculated that this might be partly because these hospitals used the HIO to look up information on patients for whom they provided unplanned care, such as those who showed up in the ER.
The authors, who included Farzad Mostashari, MD, outgoing national coordinator for health IT, suggested that information exchange will expand with the growth in EHR adoption and the spread of HIOs. Meaningful Use stage 2, which starts next year, also requires the exchange of clinical summaries in transitions of care, they pointed out. In addition, they said, ONC is working with the Centers for Medicare and Medicaid Services (CMS) to develop strategies to accelerate information exchange. They also noted that EHR certification requirements, performance measures for ONC-funded statewide HIOs, private-public initiatives, and the expansion of Direct messaging will all increase health information exchange.
Finally, the authors said that the new payment models, such as accountable care organizations, could create a "powerful business case" for unrelated providers to exchange data. Perhaps, but it's an open question whether those new payment models can thrive unless mechanisms exist to facilitate that information exchange.