Challenges involved with sharing patient health information between care providers in the US may complicate responses to national healthcare crises like COVID-19.
What we did:
During the Fall of 2019, New Heights spoke with medical information management professionals for several hospitals and other care providers. Our objectives included assessing the current state of interoperability between information systems used by different hospitals and healthcare networks.
The Healthcare Information and Management Systems Society, Inc. (HIMSS) defines interoperability as “the ability of different information systems, devices and applications (‘systems’) to access, exchange, integrate and cooperatively use data in a coordinated manner, within and across organizational, regional and national boundaries, to provide timely and seamless portability of information and optimize the health of individuals and populations globally.”
Our study occurred before the onset of the coronavirus pandemic. It was undertaken in the broader context of a Federal guideline that envisions a national level of interoperability in U.S. health information by 2024. The Center of Medicare & Medicaid Services rolled out their final mandate on interoperability between February and March, 2020. The ultimate goal is to improve patient health and lower care costs by supporting providers with a fully interoperable health IT ecosystem.
What we found:
Despite overcoming technical hurdles, interoperability remains an elusive goal because of the way information-sharing is handled in health IT.
The last ten years have seen significant software-based improvements to digital health record technology. Health IT has made steady progress on areas such as moving from paper records toward eHealth records. Electronic record sharing now regularly occurs between users of the same systems (such as Epic) within a hospital or healthcare network. However, our research indicated that the following 3 challenges present daunting obstacles for health IT professionals that are seeking greater systems interoperability.
Challenge #1: The proliferation of health information exchanges (HIEs) in the U.S.
HIEs are a popular way for hospitals, pharmacies, labs, and emergency room physicians to share patient information. Their purpose is to allow the transfer of patient medical history from one facility to another, regardless of a provider’s native record-keeping software.
There are many HIEs across the US covering local, regional, state, and national geographies. Some HIEs just share information within one hospital network, some share information across many hospitals or physicians in a region, and some HIEs share information across or between entire states. HIEs come in many varieties: some may only share lab results, some may share just emergency room records.
Healthcare providers must pay to join an HIE for access to the data housed by it – and no one HIE contains all information for all patients who could be treated by a given provider. Accordingly, if a provider wanted the complete patient data access required for true “interoperability,” then it would have to subscribe to several HIEs at the same time. This represents a prohibitive expense and management task that few healthcare networks can afford. Said one study participant, “There is no one HIE that a hospital can join and find all of the information that they need. So, we have joined multiple HIEs. But you can’t join 15 different HIEs and expect to be able to manage that. You must pick and choose who you think has your biggest partners in it, and which one your EHR supports the best.”
Challenge #2: Current HIEs can contain too much information, which may not be relevant to immediate patient care, could complicate treatment, and even endanger the patient.
Several interviewees described being inundated with patient health data that was not current, and which actually endangered patients. One Health Information Management Director told us, “We are just getting crazy volumes of data (in patients’ eHealth records). It’s daunting…It’s a safety issue.” The quantity of data adds a layer of confusion about which conditions, prescriptions, and care protocols may be active rather than inactive. Put another way, medical staff are sometimes being given a patient’s entire medical history, but without the surrounding context to interpret how to care for that individual. One Health IT Manager described this to us as carrying “inherent clinical risks.”
He elaborated, saying, “Some information is relevant to treatment, and some is not. And our HIE did not attempt to filter the data. It doesn’t look at things like inactive medications, or meds with stop dates. Nurses on the front end will get patients listed for 50 meds. But 90% of those are from years ago, inactive, stopped. They’re giving too much information to the nurses. They thought that that was safer. On the contrary, it couldn’t be any less safe.”
Challenge #3: For some healthcare providers, full interoperability requires information sharing that could jeopardize compliance with patient privacy laws.
The Health Insurance Portability and Accountability Act (HIPAA) includes strict rules regarding the privacy of medical information. Providing full (interoperable) access to patient records represents a new layer of complexity when protecting a patient’s privacy.
“The first thing we have to consider is compliance issues surrounding confidentiality,” said one Clinical Information Officer. “And I think that you’re opening a big can of worms if you allow folks access to other systems via other workstations.” This may be especially delicate territory for practitioners in facilities that provide addiction recovery or psychiatric treatment. The Informatics Director for one such facility told New Heights, “The truth is I don’t really like the idea of (direct information sharing). In mental health, you have particular sensitivities with respect to confidentiality and to privacy. These are major issues for us.”
These impediments to full health IT interoperability may hinder an optimal national response to healthcare crises, like COVID-19.
Health crises such as the current coronavirus pandemic can illustrate the need for more and broader transparency in electronic health records sharing. This is especially the case given the mobile nature of the US population. Any patient that falls ill with COVID-19 symptoms while traveling (as many seem to have done early in the outbreak) would likely benefit from having his or her complete health record immediately accessible to healthcare providers at the point of treatment. For this to occur in the future, however, the above challenges will need to be addressed.
If you have questions about trends or opportunities in healthy information, please feel free to contact us.
