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Healthcare IT Interoperability

A Six-Part Series by Will Stabler

About This Series

I wrote this article series in six parts over two months during early 2017 when there was considerable news being made and on the horizon in healthcare IT interoperability.

Articles in This Series

Interoperability is the way we get to data that can empower patients to become more involved in their health care in a way that benefits them, plans, providers and the system as well by creating a healthier overall population.
 
As efforts to achieve interoperability move forward, many challenges and obstacles lie in the way, including reluctance to share information for many reasons, including competitive advantage for both providers and developers, costs and liability.
 
This article examines the two most important users of healthcare information—the clinician and the patient—and where they interface, in the electronic Health Record (EHR).
 
Everyone involved in EHR interoperability and adoption needs to take seriously physician concerns over loss of patient interaction & the squeeze on time that can potentially result in loss of revenues.
 
5. EHR Interoperability and Adoption: To Do This We Also Need Patients
We need patients using their health information and giving their feedback to clinicians in shared decision making and care management relationships. From there we can improve the interaction that goes on there among those two human elements and the technology so we can create that world where patient-generated data comes to the forefront.
 
Interoperability should eventually take us to a place where patients and providers are enabled to work as a team toward preventive medicine and value-based care. This is a place where patients have access to their full medical records, and are working in decision making partnerships with their healthcare providers.

EHR Interoperability and Adoption: To Do This We Also Need Patients

By Will Stabler

First published on May 1, 2017

In the previous article in this series I mentioned a study released in March in which clinicians, clinical leaders and healthcare executives predicted that patient-generated data will be among the top three most useful sources of data within 5 years, although they rate that data as far less valuable when asked about its usefulness in the present. This seems to reflect anticipation among those studied that patients will be increasingly involved in their care in the not too distant future. Further, it says they believe patient-generated data—related to conditions, wellness, self-reported outcomes and more—will be a prized source of information, both clinically and in the business of health care. I believe this as well.

However, when asked about EHRs, it appears that one of the biggest tools for getting that data falls short. The findings on health information technology and EHRs from the 2016 Deloitte Study of Physicians show that among the 600 primary care and specialty physicians surveyed, 78% believe that EHRs are useful for analytics and reporting capabilities, which is the top response, and is up 10% since the 2014 survey. However, when asked if they believe EHRs improve clinical outcomes, only 47% agreed, and that is down 11 percent from the 2014 survey.

In a similar refrain to other studies mentioned earlier in this series, the Deloitte study found that 7 out of 10 physicians believe EHRs reduce their productivity. And although 3 out of 5 of these physicians say they would keep their current EHR system rather than replace it, 62% want greater interoperability and 57% want to see improved workflow and increased productivity over what they are experiencing with their current systems.

The State of the Tools and Methods We Use

Many studies show that the tools and methods we currently use for collecting, retrieving, organizing and displaying our data could use a lot of improvement, based on the experiences of the people who employ them. If physicians continue to view the EHRs as an impediment to their efficiency, quality of care, and critical face time with patients, as well as being one of their major sources of dissatisfaction and burnout, we’re not going to get to a point soon where patient-generated data is going to be highly useful.

Findings such as these show that we have some work to do in interoperability, ease of use and adoption. A greater focus on patients might be one answer.

Patient-generated data have great applicability in some of the basic foundations of value-based healthcare, including shared decision-making among providers and their patients, development of patient-reported outcome measures, more appropriate risk adjustment and reduced costs. The potentially high usefulness and value of this data are hard to argue.

But we have to get there first. For patient-reported data to gain prominence, we have to get more patients to start using EHRs and taking advantage and control of the information in them. That’s apparently not happening to a great degree, and the few patients who are using EHRs seem to be as dissatisfied with them as their care providers.

The Main Challenges We Face With Patients

According to a General Accounting Office (GAO) study released in late March, EHR use by patients is not widespread. Since 2009, HHS has invested more than $35 billion on the development and adoption of health information technology. Part of that investment is encouraging the use of technology that does three things—allows patients access to their longitudinal health information, lets them contribute to that information and gives them the ability to direct the information anywhere they want it directed.

The GAO study, using data from the 2015 EHR Program, found that when offered the ability to access their health information, only a small percentage of patients opted to do so. They found that 87% of healthcare professionals offered access to patients, but only 30% chose to access it. In hospitals, 88 percent of patients were offered that access, but only 15% of them opted to access their health information. This is despite providing them with all of the means they needed to download, view and transmit their information.

Many patients interviewed for the study said they were frustrated because their information was either incorrect or that it was presented in ways that were not helpful for their uses. Multiple patients interviewed for the study said an overall limitation was that they “could not aggregate all of their health information into a single longitudinal health record.” Although there are products available for purchase by providers and patients that can aggregate health information into a longitudinal record, patients generally don’t use them and health IT product developers say there is little demand for them.

Because of numbers like these, the GAO has determined that HHS needs to do a better job of assessing the “effectiveness of its efforts to enhance patient access to and use of electronic health information.” The GAO recommends that HHS develop performance measures to assess key efforts related to patients’ electronic access to longitudinal health information, and use the information these performance measures provide to make appropriate adjustments in its programs.

A lot more study needs to be done about both physician and patient satisfaction with the use of EHRs, but not just from their separate perspectives. There have been studies that positively associate the amount of eye gaze between the clinician and patient with the patient’s impression of the clinician’s interpersonal skills, something the EHR disrupts. We need more information from both the patient and physician on how that specific encounter is working, and how the data collected works together from a care management standpoint, involving the patient.

We need patients using their health information and giving their feedback to clinicians in shared decision making and care management relationships. From there we can improve the interaction that goes on there among those two human elements and the technology so we can create that world where patient-generated data comes to the forefront. What is the purpose of collecting data, if not putting it to work it in decision making?

In the next article I will address where interoperability and adoption are headed next.