Still not talking: Health IT interoperability remains elusive

Interoperability of electronic health records remains a bridge too far for many providers, despite more than a decade of federal emphasis on information exchange and $29.1 billion spent on federal EHR incentive payments that were ostensibly tied to meaningful-use requirements mandating interoperable computer systems.Only 11% of respondents to this year’s 25th annual Modern Healthcare Survey of Executive Opinions on Key Health Information Technology Issues said their organizations were able to routinely exchange electronic patient information with other providers across the country.That meager showing comes 11 years after President George W. Bush created the Office of the National Coordinator for Health In-formation Technology with a mandate to implement a “nationwide interoperable health information technology infrastructure.”Interoperability is shaping up to be a key feature of this week’s Health Information and Management Systems Society convention in Chicago, where Bush is booked as a keynote speaker on Wednesday. ONC chief Dr. Karen DeSalvo will press the government’s case for interoperability in her keynote speech Thursday.
The show’s 12th annual “Interoperability Showcase” should be a main attraction. Yet only 17% of respondents to this year’s survey indicated their hospitals and physician offices can move patient records around their home states. Just 21% reported they can exchange records within their regions. In contrast, 21% of respondents said they aren’t exchanging electronic information at all, either within or outside of their organizations. Still, an overwhelming majority of respondents (71%) were optimistic they’ll be able to exchange a “core data set” of patient information nationally by the end of 2017 in keeping with a goal set in the ONC’s “interoperability road map” released this January. And 72% of those taking our survey opined that achieving nationwide interoperability would be of either high value (23%) or moderate value (49%) to their organizations. The road map signaled a shift in emphasis by federal health IT policymakers away from EHR adoption and toward health information exchange.
The government now expects the huge taxpayer investment in computer technology to improve healthcare quality and safety, and lower costs.But 28% of providers question the benefits of nationwide information exchange. Physicians at Chicago’s Northwestern Memorial HealthCare, for instance, can exchange patient information nationally using an interoperability module in their EHR software developed by Epic Systems Corp., said Dr. Lyle Berkowitz, Northwestern’s associate chief medical officer of innovation.The module, called Care Everywhere, can connect the developer’s customers and anyone else that uses industry standards. Berkowitz also expressed confidence that Northwestern would meet the ONC’s 2017 interoperability goal, which is limited in its data set.He placed “low value” on nationwide interoperability. Berkowitz said that as a primary-care physician, “nationwide exchange is not particularly needed.”“Local exchange is helpful, however,” he said, for example, if a patient from one organization appears in the emergency room of another. “For our specialists, however, the nationwide exchange might make sense.”
But Steve Long, CEO of Hancock Regional Hospital, Greenville, Ind., sees the need for the broadest level of interoperability, giving it “high value” on the survey. “As I look to the future of healthcare, it’s all about population health,” he said. “In order to really manage a population, we need to have complete interoperability. If we don’t have that with our tertiary partners, post-acute-care providers, (for) population management all up and down the continuum of care, we won’t get there.” While the federal government a year ago postponed implementation of the ICD-10 diagnosis and procedural coding system until October, survey respondents do not believe another postponement is in the offing. Preparing for the switch topped this year’s list of survey “hot button” priorities.
At 25-bed Ray County Memorial Hospital in Richmond, Mo., ICD-10 readiness was certainly one of Chief Financial Officer Donald Harr’s hot-button priorities. Harr was among the 42% of survey respondents who were “somewhat confident” they’ll be ICD-10 compliant by deadline.“We have a certified trainer on ICD-10 that gives us an edge,” Harr said. “She’s gone to all the departments twice and she has to go back to all of them again” before Oct. 1. Harr was among the plurality (48%) not in favor of delaying or scrapping ICD-10. “It’s going to happen,” Harr said. “I’d just like to get it over with.”Perhaps more of a surprise was the second-place ranking among hot-button issues for the adoption or upgrading of financial, clinical and analytic systems to handle the demands of accountable care organizations and patient-centered medical homes.
“We’ve done a lot of work on population health management with very little health IT infrastructure,” said Dr. Farhan Fadoo, chief medical information officer at San Joaquin General Hospital in French Camp, Calif. In 2011, the 196-bed safety net hospital began using a specialty software system for population health, i2iTracks, with “largely a paper-based workflow.” “There was a lot of manual entry, but it’s paid big dividends in getting us ready for risk-based contracting,” Fadoo said. Now, as the hospital prepares to buy and install a comprehensive EHR, a goal is to ensure no population health-management capabilities are lost in the transition, he said.