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EHR Roadblocks Holding Docs Back

Current systems lack interoperability, experts say

In an interview with Healthcare IT News, Steven J. Stack, MD, president-elect of the American Medical Association, said that doctors are finding it difficult to exchange and share data between current electronic health record (EHR) systems mostly because of “an overabundance of measures with specifications that are unaligned,” creating confusion for overburdened physician practices.

“A recent study found this uncoordinated approach resulted in too much variability in the large array of measures being promoted across the health care system,” Stack noted.

The study in question, issued by the RAND Corporation, found that physicians faced roadblocks to data analytics caused by missing quality performance feedback or drug prices. The authors recommended addressing physician concerns about operational issues to improve the effectiveness of alternative payment models.

“The underlying problem is EHRs don’t talk to each other very well,” said the study’s lead author, Mark Friedberg, a senior natural scientist at RAND. He noted that interoperability “has never been incentivized by the Office of the National Coordinator for Health IT.”

Anna Orlova, senior director of standards at the American Health Information Management Association (AHIMA), underscored the importance of getting interoperability standards back on track.

“In the past 6 years, we’ve seen a derailing of ‘government as leader’ in the private–public partnership of developing standards needed by physicians,” she told Healthcare IT News. “We’re so far behind half the world. Estonia is ahead of us.”

Immature standards prevent existing health IT systems from cooperating, she added.

“The government doesn’t mandate standards,” Orlova said. “We need to create interface standards for semantics, technical and functional.” Instead, she pointed out, today’s standards exist only for technical aspects of interoperability.

Stack agrees. “Many of the exchange requirements and functional objectives identified in these programs are based on immature standards that are untested, underdeveloped, or lack market consensus,” he said. “The federal government could incentivize and direct health care interoperability through policy measures, such as meaningful use and the standards and interoperability framework originated by the Health Information Technology Policy Committee.”

EHR certification is one way interoperability could be enforced, Friedberg suggested.

“For physicians to receive a bonus through meaningful use, they have to use certified EHR,” he said. “Conceivably, that could put pressure on EHR vendors to become certified and ensure that physicians are meeting MU [meaningful use] requirements.”

Stack called new medical coding diagnostic changes slated for October “one more burden facing physicians,” noting that “every certified EHR needs to have updated software to handle ICD-10 coding. There could be a considerable number of challenges during the transition.”

Orlova put it more bluntly: “Physicians shouldn’t be struggling with this stuff,” she said. She expects that collaboration between AHIMA and the Healthcare Information and Management Services Society (HIMSS) will result in a blueprint for interoperability standards within 2 years.

“Chasing data for uncoordinated measures requires significant time and resources that could be better spent on patient care or technology that practices need to achieve desired outcomes for patients,” Stack said. “Efficient data flow is key. Data must drive the rapid cycle- design and implementation of quality improvement efforts.”

Source: Healthcare IT News; June 1, 2015.

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