Interoperability Challenges Aren’t Stopping Hospitals from
Sharing Data to Improve Care

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Clinical Data Integration thumbnailLehigh Valley Community Hospital in Pennsylvania saw very consistent results when it had diabetes patients self-report their glucose levels. The results became real after the hospital began using remote glucose monitors. Care ultimately improved, but not before the hospital put the results in the right hands, which involved scanning documents so the data could be entered into the electronic health record system.

“Being able to see the actual data in real-time is key to changing behaviors,” says Sharon Kromer, BSN, RN, CCRC, CTC, the clinical coordinator at Lehigh Valley Health Network’s Center for Connected Care & Innovation. “If a blood sugar reading is way off one day, a nurse can call to check on the patient to see what may have happened. Patients like that arrangement. For us, the biggest challenge is getting data to care providers.”

Colorado’s Mt. San Rafael Hospital saw a similar opportunity to improve care with remote monitoring, but faced a different problem. The hospital has separate electronic health record (EHR) systems for its ambulatory patients and inpatients, plus a patient health portal where all medical records and information come together, and wants to supplement it with data from wearable devices like the Fitbit. The systems are not interoperable, which has kept the IT staff busy working on integration.

Mt. San Rafael is not alone — improved interoperability and standards could save the U.S. health system $8 billion annually, with 90 percent of the savings going to providersi, according to a Council of Affordable Quality Healthcare (CAQH) data published in an American Hospital Association (AHA) TrendWatch in January 2016.

Pull Quote“There have been areas of improvement, but they are not necessarily aligned with needs,” says AHA Vice President of Health Information and Policy Operations Chantal Worzala. “For example, more patients are using portals, but hospitals can’t always get the information they need out of them.”

A 2014 studyii found that 78 percent of EHR systems can share data by sending it to another EHR, health information exchange (HIE) or patient portal, but only 56 percent could receive data from other EHRs. That gap illustrates how the lack of interoperability makes it challenging to get patient information from different sources into the right hands when needed. Lack of interoperability tied with cost as the leading obstacle to achieving the full potential of health IT, according to Why Interoperability Matters, a 2015 report by the AHA. Interoperability was cited as a major obstacle by 95 percent of survey respondents. For comparison, less than half as many (43 percent) cited protecting patient privacy and the confidentiality of patient data as a top obstacle, even though it is a high-profile issue that drives millions of dollars in spending annually on information security systems and staff training.


Providers Are Making Progress


Pull QuoteThe barriers to sharing clinical data among different providers are well known, and have existed for a long time. What’s less known is the progress being made in integrating clinical data to improve care. For example, in addition to its successful remote patient monitoring programs, Lehigh Valley Community Hospital has integrated its EHR directly with ICU monitors to provide information in real time, and has a cloud computing infrastructure to share radiology images and improve care coordination. Mt. San Rafael Hospital credits its patient portal for helping improve continuity of care by enhancing data collection and sharing. It has also reduced redundant testing by participating in a health information exchange (HIE). The Why Interoperability Matters report summarizes programs at Children’s Hospital Boston, Citizen’s Memorial Hospital, Truman Medical Centers and other organizations where HIT integration has resulted in higher quality of care.

More than four out of five acute-care hospitals are now electronically exchanging lab results, radiology files, clinical care summaries or medication lists with ambulatory care providers or hospitals outside their own systemsiii. That represents a 20 percent increase in three years and a doubling in electronic information exchange participation since 2008 (see Figure 1). Sixty percent of hospitals were exchanging the more comprehensive clinical/summary of care record with hospitals outside their system. In 2015, 37 percent of hospitals accepted patient-generated data online, up from 14 percent in 2013iv.

Figure 1: Percent of Non-federal Acute Care Hospitals Electronically Exchanging Select Medical Information with Ambulatory Care Providers or Hospitals Outside Their System

figure 1 thumbnail

Source: ONC/American Hospital Association, AHA Annual Survey Information Technology Supplement

Despite this progress, clinical data integration remains very challenging. Hospitals are succeeding in part because integration is becoming easier — but often it’s because they employ additional solutions to supplement their EHRs, or rely on manual methods to share information.

Pull QuoteACO participants rated web portals the most effective tool for communication in a studyv by the Ponemon Institute that was sponsored by Imprivata; 65 percent of the survey participants cited web portals as an effective method. Secure text messaging, which some hospitals are using to replace paging, ranked second and was cited by 56 percent of survey respondents. Electronic medical record systems came in third at 56 percent, while only 11 percent of respondents cited health information exchanges as an effective tool. Open application programming interfaces (APIs) plus HL7 and other standards hold promise for making HIEs and EHRs more interoperable and effective, but they have not achieved the breadth of adoption nor depth of integration that hospitals require today.

“We need the vendor community and providers to work with each other and with the policy world to achieve interoperability in a way that will make information exchange more efficient,” says Worzala.

Until then, hospitals will continue to try manual workarounds like scanning, faxing and keyboarding to get information from different sources into their EHR systems. Mt. San Rafael Hospital uses a patient portal solution from YourCareUniverse to collect valuable patient data, but still resorts to manual integration to move data from its portal and other sources into different clinical systems. It takes a lot of work, but according to Michael Archuleta, BSIT, the hospital’s director of IT, it’s worth the effort: “We might not be providing direct care to patients, but the technology we’re configuring, building and supporting is really saving lives.”

i Council for Affordable Quality Healthcare. 2014 CAQH Index.
ii Vaishali Patel, PhD MPH; JaWanna Henry, MPH; Yuriy Pylypchuk, PhD; Talisha Searcy, MPA, MA. Interoperability among U.S. Non-federal Acute Care Hospitals in 2015. ONC Data Brief 36 May, 2016/ONC American Hospital Association Annual Survey Information Technology Supplement.
iii American Hospital Association TrendWatch. Individuals’ Ability to Access Their Hospital Medical Records, Perform Key Tasks is Growing. July 2016.
iv Ibid.
v Ponemon Institute. The Imprivata Report on the Economic Impact of Inefficient Communications in Healthcare. June 2014.  

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