Inside the struggle for electronic health record interoperability

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It is a growing issue everywhere from the examination table in your physician’s office to your hospital system’s database to the halls of Capitol Hill. The health care system at large is trying to move your health record off of a paper chart and into the digital space. Furthermore, your electronic health record (or EHR in health care parlance) should be able to to freely move between your physician to your hospital or anywhere crucial in between. Only that increasingly isn’t the case.

Over the past few months, stories have popped up chronicling doctors’, clinicians’ or other health care providers’ headaches moving to and/or accessing EHRs. The chorus of complaints has led the Senate Appropriations Committee to submit language in a draft bill that calls for a report from the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) on what “the challenges and barriers” are to EHR interoperability.”

Whatever challenges and barriers there are, it is clear both hospitals and office-based physicians are struggling to meet HHS’ Meaningful Use Criteria, which include interoperability guidelines.

Small clinics suffer

In a study published in the September 2014 issue of Health Affairs, a number of analysts — including some working for ONC — found that while the rates of hospitals adopting basic EHRs continue to rise, only 5.8 percent of hospitals surveyed were able to meet all of 16 core objectives put forth in HHS’ Meaningful Use Criteria. The areas in which hospitals were most lacking were providing patients with the ability to view and download their information and sending care summaries between care settings.

In another study that examined EHR adoption in office settings, only four in 10 physicians had any electronic exchange with other health providers, and one in seven exchanged clinical data with providers outside their organization.

Both studies found that in some respects, the more resources available to a hospital or an office, the more likely they were to have already implemented EHRs. In the study that focused on hospitals, more than half of all rural hospital respondents said they had “less than basic” EHR implementation in 2013. In the study dedicated to office-based care, solo practitioners and specialty physicians lagged behind larger practices or primary care physicians.

The lag is something ONC has tried to combat since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of 2009’s American Recovery and Reinvestment Act. The act, which designated $30 billion to build a nationwide system of electronic health records, established 62 Regional Extension Centers (RECs) to provide guidance to local health care providers.

The RECs have been beneficial on the local level. According to ONC, as of July 2013, more than 70,000 providers had demonstrated some form of meaningful use. However, as the hospital-based survey states, the RECs’ efforts are not enough to combat the lag in meeting meaningful-use standards.

Anita Somplasky, the director of measures and support at Quality Insights, a nonprofit health care company that serves as a REC in Pennsylvania, agrees that the cards are stacked against smaller practices who are trying to meet the requirements of meaningful use.

“Small and medium practices are absolutely struggling,” Somplasky said, adding that trying to meet meaningful use standards has been a “slow, slow process.”

Somplasky said she has been dealing with EHR interoperability issues for years, including one that would have allowed more than 900 providers to send secure emails to one another. But three years went by before a solution was provided by vendors.

Even with ONC and the Centers for Medicare and Medicaid Services delivering marching orders for providers to follow, Somplasky said smaller practices are considering taking the financial penalties that come with failing to meet the HHS meaningful use goals.

“Here in Pennsylvania, folks have to pay the state to do syndromic surveillance (the analysis of medical data to detect or anticipate disease outbreaks) or for the immunization registry,” Somplasky says. “That’s $4,000. If the penalty is $3,000, why would I pay $4,000 to login to the state and then another $4,500 for the patient portal? That’s just the unfortunate financial reality.”

Even small practices that have seen the firsthand upside of EHRs still have to create workarounds so their systems can communicate with others outside of their practice.

Mary Beth Byrnes, who helps manage a four-person family practice in Souderton, Pennsylvania, was an early adopter of EHRs, integrating SOAPware into her practice in 2005. Even as Byrnes invests heavily as updates roll out, she said she still has to create workarounds in order to stay on top of patient records.

Byrnes told FedScoop that while she can pull information from other sites, she’s not able to make lab orders electronically. She also said her reporting capability within SOAPware is not very robust, causing her to create a workaround to where she will manually submit queries to obtain data.

While Byrnes said this doubles her workload when working with the program, she needs to do it in order to keep up with any updates SOAPware will roll out in the future.

“Especially as a solo practice, if we don’t get on top of this, we might as well pack it up, close down and go home,” Byrnes said.

Dr. Jorge Schierer, chief medical information officer for Pennsylvania-based Reading Health System, understands that small practices like Byrnes’s face bigger hurdles than large hospitals or health systems.

“The smaller the practice is, the harder it is to do all the things that you need to do to be successful,” Schierer said. “The expense of purchasing, maintaining and optimizing electronic medical records is not insignificant. It’s not offset significantly enough by the potential dollars that you could capture from meaningful use.”

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electronic health records (EHRs)
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