Despite more than $24 billion in incentive payments to hospitals and eligible professionals who "meaningfully use" electronic health records and another $2 billion spent on interoperability standards and EHR certification, there is very little electronic information sharing among providers.

That is the conclusion of a new health policy brief from the journal Health Affairs and the Robert Wood Johnson Foundation authored by Janet Marchibroda, director of the Health Innovation Initiative at the Bipartisan Policy Center.

“While considerable investments in health IT have been made, advancement of interoperability and electronic information sharing across systems has been slow,” Marchibroda writes. “Additional action is needed to provide the information foundation necessary for higher-quality, more cost-effective, patient-centered care in the United States.”

The primary barriers to electronic information sharing include the lack of a business case, the cost associated with exchange, lack of standards adoption and interoperability of systems, some continued concerns about privacy and security, and concerns about liability.

Because most payment in the U.S. healthcare system today is volume based versus outcomes or value based, “there is little financial incentive to share information across settings to reduce costs or improve the quality of care.” Although new care models are expected to expand the business case for interoperability and information sharing, Marchibroda finds that “so far these new models of care have relied upon old models of information sharing, including the use of phone, fax, or mail, or siloed information-sharing networks.”

According to a recent study published in Health Affairs, a mere 14 percent of physicians surveyed in 2013 were electronically sharing data with providers outside of their organizations. And, another study cited by the brief revealed that only 10 percent of ambulatory practices and 30 percent of hospitals were found to be participating in operational health information exchange efforts.

“In order to achieve electronic information sharing, EHRs and other clinical software must be ‘interoperable’ or have the capability to exchange information using agreed-upon standards, and those providing care and services must be willing to share information,” Marchibroda argues.

Nevertheless, she asserts that the requirements for both interoperability and electronic information sharing under the HITECH Act to date have been “fairly limited.” Specifically, Marchibroda references Stage 1 of the meaningful use program.

“Stage 1 made it optional for providers transferring a patient to the care of another provider to furnish that provider with a summary of care record 50 percent of the time, and noted that such information need not be transmitted electronically,” she states.

However, Marchibroda describes Stage 2 MU requirements as “more robust” and sees Stage 3 as a “significant opportunity to advance the interoperability of EHR technology and electronic information sharing among providers.”


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