True health information exchange won't happen until a majority of providers have installed and are successfully capable using EHRs, report says

ONC cites security, incentive woes among 5 biggest interoperability roadblocks

By Jessica Davis
10:51 AM
Stressed doctor

Substantial interoperability has yet to be achieved across healthcare, a recent report to Congress from the Office of the National Coordinator's Health IT Policy Committee shows, held up by reasons including lack of standardization and security concerns.

[See also: AMIA: Why interoperability is 'taking so darn long'.]

Here are the five major roadblocks to more widespread data sharing, according to the ONC:

1. Lack of universal standards-based EHR systems' adoption. True health information exchange won't happen until a critical majority of providers have installed and are successfully capable using EHRs. Incentive programs have increased adoption nationwide; policymakers must continue to help the remaining providers make the transition.

2. Impact on providers' day-to-day workflow. Technology has reached the capability of making interoperability possible, but process innovation has yet to catch up. Existing processes must be redesigned to incorporate new technologies – a more prominent problem in the healthcare arena, mostly due to a lack of standardization.

3. Complex privacy and security challenges associated with widespread HIE. Adequate privacy and security is at the forefront of healthcare institutions. The ONC has found HIPAA misunderstandings and privacy law translations detrimental to security, while electronic system design and accommodation rules for privacy laws have been formidable.

[See also: Redirecting ONC's interoperability roadmap.]

4. Need for synchronous collective action among multiple stakeholders. It's crucial for all participants to agree on the "rules of the road," especially related to the above issues, if effective interoperability is possible. Standards and rules for patient access must be uniform to bridge existing and future networks.

5. Weak or misaligned incentives. Economic incentives for interoperability can discourage providers. And traditional fee-for-service payment models aren't enough to persuade providers the extra work is worth it. EHR developers have focused more on a fee-for-service model in the past, thus lowering the demand for interoperability.

Included in the report are ONC's recommendations on processes to establish over the next six months to foster better interoperability. They are:

1. Develop and implement meaningful measures of the health information exchange-sensitive health outcomes and resource use for public reporting and payment.

2. Develop and implement HIE-sensitive vendor performance measures for certification and public reporting.

[See also: Interoperability is 'impossible in the abstract'.]

3. Set specific HIE-sensitive payment incentives that incorporate specific performance measure criteria and an implementation timeline, establishing clear objectives of required accomplishments under alternative payment models.

4. Convene a Summit of major stakeholders co-led by the federal government (such as, ONC and CMS) and private sector to act on the ONC roadmap to accelerate the move toward interoperability.

To be successful, interoperability will require "multiple stakeholders to act in a coordinated manner," according to the report's authors.

Twitter: @JessiefDavis