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.
By Will Stabler
First published on April 11, 2017
In the first two articles in this series I addressed efforts to achieve interoperability in health care and some of the business case for it. Now it is time to talk about some of the challenges. For that we need to look to our two most important users of healthcare information—the clinician and the patient. The place where they interface, technologically speaking, is in the electronic health record (EHR).
First let’s look at physicians, who should be considered just as much clients of the EHR as patients, because they are. And by many accounts, physicians are not happy customers when it comes to EHRs. A recently released national survey of more than 17,000 physicians found that many of them are unhappy in their chosen profession. A lot of them say they are burned out and don’t have the time for the most important part of their jobs, and the part that makes them happy—their patients. A lot of them blame EHRs for this.
The survey, released this past September and titled, “2016 Survey of America’s Physicians: Practice Patterns and Perspectives” was conducted on behalf of The Physicians Foundation by Merritt Hawkins. Among its findings were that only 10.9% of physicians say EHRs have improved patient interaction, while the remaining 89.1% say they have had little or no impact or have detracted from patient interaction. When it comes to the effect of EHR use on job efficiency, 74.7% of physicians say that EHR use has had little or no impact, or that it has detracted from efficiency.
Only 29.8% of physicians responding to this survey indicated that the EHR has improved the quality of care in their practices, while the other 71.1% reported that it has had little or no impact or detracted from the quality of care.
In the Physicians Foundation report, respondents were asked what statement they would make to policy makers and the public about the state of the medical profession and America’s healthcare system. Some of these comments from respondents were published anonymously in the report. One of them expresses some of the frustration over EHRs: “There is undue pressure on the doctor to do about 20 things besides see the patient at each visit. I see doctors now who hate to go to work because of the drudgery of EHR and prescribing restrictions.”
So what is the biggest problem with EHRs? Is it a capabilities issue? Ease of use?
A report released last month and conducted for NEJM Catalyst titled, “Care Redesign: What Data Can Really Do for Health Care,” found something that might seem surprising to some. In this survey of nearly 700 healthcare executives, clinical leaders and clinicians, more than three-quarters (76%) of respondents rated the capabilities of their EHRs as either “strong” or “average,” but rated interoperability as the largest problem, with 51% of them labeling the interoperability of their EHR systems as “weak.”
The NEJM study also found that less than 20% of survey respondents believe their organization’s use of data for direct patient care is “extremely effective” or “very effective.” When asked to choose the top three biggest barriers to better use of patient data, respondents listed lack of interoperability as the number one issue (72%), followed by difficulty collecting data (62%) and time required (60%). It is important to note that a higher percentage of executives (79%) than physicians (69%) listed lack of interoperability as the number 1 issue.
In researching the real and perceived challenges of interoperability in EHRs I found an FAQ at HealthIT.gov, that makes a good attempt at trying to answer a critical, but complex question:
“What is EHR interoperability and why is it important?
“A complex health care system requires diverse electronic health record (EHR) products. One size does not fit all. To realize their full potential, EHR products must be able to share information seamlessly. An interoperable health IT environment makes this possible.
“EHR Interoperability enables better workflows and reduced ambiguity, and allows data transfer among EHR systems and health care stakeholders. Ultimately, an interoperable environment improves the delivery of health care by making the right data available at the right time to the right people.”
Amy Compton-Phillips, MD, is Executive Vice President and Chief Clinical Officer for Providence St. Joseph Health System and NEJM Catalyst Lead Advisor for Care Redesign. In her analysis of the report for the NEJM study, she commented on the interoperability and integration challenges in EHRs. “The effort required to obtain critical inputs such as patient-generated data, feed it into EHR systems, and then be able to analyze it for actionable insights has been a significant hindrance to broader adoption,” Compton wrote. “For patient data to become more impactful in health care, provider organizations will have to figure out how to efficiently obtain, integrate, and share information across disparate systems.”
In the next article, I will address some of the progress being made to help increase EHR adoption and improve how organizations use their patient data.