Just a month after the AAFP suggested(5 page PDF) how legislators should press electronic health record (EHR) vendors to make sure their various systems can exchange data, the companies that provide 90 percent of EHR systems — along with some of the largest private health care systems — agreed to improve data sharing.
The companies announced on Feb. 29(www.hhs.gov)that they’ve made three commitments to improve consumers’ and physicians’ ability to share health information. They pledged to
- help consumers easily and securely access their electronic health information, direct it to any desired location, learn how their information can be shared and used, and be assured that this information will be used effectively and safely to benefit their health and that of their community;
- help physicians share individuals’ health information for care with other physicians and their patients whenever permitted by law and not block electronic health information; and
- implement federally recognized, national interoperability standards, policies, guidance and practices for electronic health information and adopt best practices including those related to privacy and security.
Cerner Corp., Epic Systems Corp., Allscripts, NextGen Healthcare Information Systems Inc. and GE Healthcare were among the 17 health IT vendors to commit to improving EHRs, according to an HHS factsheet.(www.hhs.gov)Sixteen health care systems, including Ascension Health, Catholic Health Initiatives, Community Health Systems, Hospital Corporation of America, Kaiser Permanente and Trinity Health, also made the pledge.
The AAFP was one of 16 medical organizations also to commit,(www.healthit.gov) noting that the Academy “shares the principle that to achieve an open, connected care for our communities, we all have the responsibility to take action. The AAFP has long worked for interoperability in support of continuity of care and care coordination.”
“The future of the nation’s health delivery system is one where electronic health information is unlocked and shared securely, yet seamlessly, to put patients at the center of the their own care,” said Karen DeSalvo, M.D., M.P.H., M.Sc., national coordinator for health information technology, in the news release. “The broad agreement by leaders in health and health IT across the nation brings us much closer to our vision for a truly learning, connected health system.”
AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., told AAFP Newsthat this is exciting news for family physicians.
“The siloed type of records we have now sometimes creates obstacles for using information to create the best care for patients, especially for those in transition or with complex illnesses,” he said.
Interoperability, the ability for different health IT systems to communicate with each other and exchange data, is critical for family physicians, Wergin said. “We are a specialty that interacts with all phases of the health care system. We must have the information we need to formulate treatment plans and create the best outcomes. Lack of interoperability creates problems.”
Overcoming EHR Information-sharing Hurdles
In addition to not following standard interoperability guidelines, EHR systems and health care professionals have been known to block information exchanges.
The Office of the National Coordinator for Health Information Technology (ONC) has received complaints that “developers charge fees that make it cost-prohibitive for most customers to send, receive or export electronic health information stored in EHRs or to establish interfaces that enable such information to be exchanged with other providers, persons or entities.” This is according to an ONC report(www.healthit.gov) from April 2015.
Health care professionals also have been accused of information blocking in order to “control referrals and enhance their market dominance,” the same report found.
Blocking the exchange of EHR information is often cited as a business model, Wergin said. “It might be a good business model, but it’s not a good health care model.” When health care professionals’ EHR systems can’t communicate with each other, physicians resort to printing and faxing lengthy reports and discharge summaries.
“The current system of faxing information is really a page back to our old paper charts,” Wergin said.
Interoperability is critical for family physicians for three reasons, said Steven Waldren, M.D., director for the Alliance for eHealth Innovation at the AAFP.
“From our perspective, we need continuity of care, we need to be able to do good care coordination and we need substitutability of the product so we’re not locked into a particular product or vendor,” he said. “It is critical that the private and public sector all row in the same direction. Interoperability is such a huge problem; it’s going to require participation from everyone in the community.”
Putting This Announcement in Context
The HHS announcement comes just a few weeks after the Senate Committee on Health, Education, Labor and Pensions approved a bill to make health IT more useful.
The Improving Health Information Technology Act(www.help.senate.gov) would establish standards for interoperability, EHR vendor performance and care coordination in health IT systems.
Specifically, the bill directs HHS to create standards for information exchange among IT vendors and to further define information blocking. The act also would create a council to rate health IT companies. Prior to the bill’s committee approval, the AAFP submitted recommendations and testified about the difficulties physicians face when using health IT in silos.
“These are all steps towards the goal of getting interoperability,” Wergin said. “The HHS plays an important role in standardizing and making mandatory the platforms for interoperability between vendors. It’s nice to see HHS saying it’s committed to getting this done.”
