Hospitals record progress in electronic information exchange

U.S. non-federal acute care hospitals in 2014 had widely varying experiences regarding the state of interoperable exchange activity within their facilities, according to new baseline estimates provided by the Office of the National Coordinator for Health Information Technology (ONC). Following up a prior analysis from 2008 indicating an 85 percent increase in hospitals electronically exchanging information (see Acute care hospitals exchanging more electronic health information with outside Providers, Health Law Daily, April 16, 2015), the ONC’s new analysis found that four in 10 hospitals have access to necessary patient information electronically available from care settings outside their systems, have the infrastructure to enable exchange, and are electronically exchanging health information with trading partners.

Nationwide interoperability

Interoperable exchange activity is the ability for hospitals to electronically find, send, receive, and use health information from other systems, where “find” refers to hospitals’ ability to query patients’ health information from external sources and “use” is the ability to integrate summary of care records without manual entry. The ONC’s draft Nationwide Interoperability Roadmap outlined strategies to enable nationwide interoperability so that individuals and providers across the care continuum could electronically send, receive, find, and use a common clinical data set. The availability of this key clinical information at the point of care has important implications for patient safety and care coordination.

Currently, only 25 percent of hospitals engage in all four activities, i.e., send, receive, find, and use, related to interoperable exchange. Hospitals engaging in more than one of the interoperable exchange activities were found to have higher levels of information electronically available from outside settings. Nearly 90 percent of hospitals that engaged in all four interoperable exchange activities had the necessary clinical information electronically available from outside providers or sources when treating patients. Hospitals that conducted all four interoperable exchange activities were over nine times more likely (86 percent) to have necessary clinical information electronically available from outside providers or sources at the point of care than hospitals that conducted none of these activities (9 percent).

Electronic barriers

Despite the potential benefits of electronic exchange, a majority of hospitals used a mixture of paper and electronic methods to exchange information. Few hospitals used electronic-only means of sending (9 percent) and receiving (7 percent) summary of care records electronically. For most hospitals, the interoperability barrier was due to the lack of exchange partners with the capability to electronically receive information. Almost 25 percent of hospitals reported that they had to pay additional costs to send/receive data with trading partners outside of their organization. Almost half of hospitals reported difficulty locating providers and about a quarter reported difficulty matching or identifying patients. Surprisingly, 10 percent of hospitals reported that they did not typically share their patient data with care settings outside their system.

Future actions

The baseline estimate suggested that there is room for improvement. While the ONC found that most hospitals have electronic health records and are actively exchanging health information electronically, important work remained to ensure that the necessary clinical information was available at the point of care in hospital settings. To that end, the ONC would continue in its development of a nationwide interoperability roadmap.