Lack of EHR, data interoperability holding back value-based care

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The lack of electronic health record interoperability and sharing of patient data continue to be major barriers to value-based care in Medicare.

That’s the consensus of healthcare stakeholders who testified late last week before the House Energy and Commerce Health Subcommittee.

Nishant Anand, MD, chief medical officer for Adventist Health System, said that about two thirds of the physicians that his organization works with across its ACOs and clinical integrated networks are independent—and, as a result, operate more than 30 different EHR platforms.

“This makes it increasingly difficult to share patient information between the providers that make up our network,” said Anand in his testimony. “The result is a consumer experience that is difficult and cumbersome, tests and treatments that are duplicated, and vital lifesaving information that is not always available.”

Also See: Multiple EHRs, lack of interoperability hamper Next Generation ACOs

“To optimize the effectiveness of ACOs, more progress needs to be made in data sharing and data interoperability so that entities have real-time knowledge of workflows, care coordination and progress towards quality measures,” Mary Grealy, president of the Healthcare Leadership Council, told lawmakers.

Grealy noted the importance of technology in the successful transition from Medicare fee-for-service to value-based care.

“Specifically, the expanded use of telemedicine is essential in more efficient utilization of healthcare resources and expanding the reach of health providers,” Grealy testified. “We urge Congress and the administration to further address Medicare’s restrictions on reimbursement for telemedicine services.”

She also made the case for making digital health apps more accessible for Medicare beneficiaries.

“To truly partner with private practice physicians, we want to share technology services such as clinical decision support tools, telemedicine platforms, and referral solutions,” Anand told lawmakers. “I know these tools will help us make better decisions for patient care that will ultimately lead to better outcomes and lower cost.”

However, he added that real-life operational challenges regarding interoperability, sharing enabling technology with physicians and navigating the care of patients are impediments for providers to participate in value-based arrangements.

According to Anand, one of the biggest challenges to achieving interoperability is the lack of a national patient identifier, which makes it difficult for data to be exchanged seamlessly between healthcare organizations.

“Regardless of the electronic system, there will always be variability in the registration and data entry processes at each organization,” stated Anand. “This will prevent the healthcare industry from achieving full positive identity matching. Moreover, EHR systems are expensive and there is a lack of competition with, what are essentially, monolithic EHR systems. We believe that the federal government has an important role to play in addressing these issues and advancing reforms that will improve the interoperability of EHR data.”

Adventist Health System recommends that the Office of the National Coordinator for Health IT take the following actions to improve interoperability:

  • Designate an open application programming interface (API) standard(s) for EHRs (such as FHIR and CDS hooks) to ensure that APIs are implemented consistently and to ensure fair market adoption and implementation across EHR platforms.
  • Enable providers to connect any third-party application (conformant to the recognized standard API and successor standards) of their choosing to their EHR.
  • Allow providers to be able to use third-party applications (conformant to the recognized standard API and successor standards) without obtaining “permission” from or pre-registering the app with their EHR vendor.
  • Ensure APIs support bulk data extract and real-time data update and exchange.
  • Do not allow EHR vendors to put limits on the data extracted or the frequency of data requests.
  • Require certified EHR vendors to disclose all known material limitations (such as fees or costs) associated with their API’s functionality and app integration services and capabilities.

“By taking these steps, ONC will facilitate the development of applications that can provide clinical decision support and other tools that providers can use to improve the quality and cost effectiveness of care,” concluded Anand. “It will also enable the exchange of data between different EHR systems.”

Morgan Reed, executive director of the Connected Health Initiative (CHI), said in his testimony that a diversity of APIs are emerging to assist in bringing patient-generated health data into the continuum of care, but that not all of these are necessarily well integrated with EHRs.

“While certified EHR technology will be required to support APIs, many vendors will enable ‘read only’ access, allowing for data to only flow out of the EHR rather than both in and out,” testified Reed. “Additionally, we are aware that CEHRT vendors have not implemented a common approach to API development and lack a consistent implementation of API technical standards, creating ‘special effort’ to develop applications and undue burden and costs for our members. CHI reiterates our concern with, and lack of confidence in, any presumption that the 2015 ONC CEHRT standards will facilitate seamless interoperability.”

In addition, Reed warned in his testimony that interoperability must not only occur between providers but also between remote patient monitoring products, medical devices, and EHRs.

“A system demonstrating ‘widespread interoperability’ will provide useable data from various sources, not just from certified EHR technology and CEHRT systems,” emphasized Reed. “We strongly encourage this subcommittee to ensure HHS’ interoperability efforts prioritize data generated by patients outside of the traditional care setting.”

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