What are the Challenges and Solutions for EHR Interoperability and Data Exchange?

The adoption of electronic health records (EHRs) and the digitization of health information have opened up new avenues for managing patient data. Outsourcing medical transcription is a practical approach to guarantee precise and timely EHR documentation. Nevertheless, achieving EHR interoperability, i.e., the capability of exchanging EHR data among diverse healthcare providers, is vital for enhancing patient outcomes, minimizing medical errors, and decreasing costs.

To achieve interoperability, healthcare organizations need to adopt and adhere to common technical standards, such as the Health Level Seven International (HL7) standard, which defines a common language for exchanging health information. They also need to develop policies that govern the collection, use, and sharing of health data to ensure patient privacy and security. The 21st Century Cures Act aims to promote health data interoperability by requiring healthcare organizations to allow patients to access and share their health data electronically.

The goal of the Shared Nationwide Interoperability Roadmap for 2021-2024 is to “achieve nationwide interoperability to enable a learning health system with the person at the center of a system that can continuously improve care, public health, and science through real-time data access” (www.healthit.gov)

However, accomplishing interoperability in healthcare is no small feat. Let’s explore the challenges for EHR interoperability and the solutions.

What is EHR Interoperability and Why is it Important?

The National Alliance for Health Information Technology defines interoperability in the context of healthcare as “the ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged”.

Sharing patient health information between different healthcare providers, payers, patients, and locations in a seamless manner is crucial for improving patient care, reducing medical errors, and facilitating better population health management. When health data is siloed in different HIT systems, it can lead to fragmented care and a lack of coordination between providers, which can impact health outcomes for patients.

With population aging and people living longer, interoperability and data sharing is becoming increasingly important for effective healthcare delivery. The Agency for Healthcare Research and Quality (AHRQ) has estimated that approximately two-thirds of older Americans have at least two chronic physical or behavioral conditions. Healthcare expenditure for individuals with multiple chronic conditions amounts to an estimated 66% of the total healthcare costs in the US, according to AHRQ. Health data interoperability is essential for creating a more connected and efficient healthcare system that puts patients at the center of care.

The benefits of health data interoperability include:

• Improved patient outcomes: When healthcare providers have access complete and up-to-date patient information it can drive informed treatment decisions, improved care coordination, and better care outcomes.
• Increased efficiency: Interoperability enables more efficient care delivery and reduced administrative burden by reducing the time and resources required to share health data between different providers
• Better patient engagement: When patients have access to their health data and can share it with different providers and healthcare organizations, it can improve patient engagement and support more personalized care.
• Cost savings: By preventing medical errors, reducing unnecessary tests and procedures, and improving care coordination, interoperability can lead to cost savings for providers and patients.
• Improved population health management: When healthcare organizations can aggregate and analyze health data across different systems, it can inform population health management strategies and support public health initiatives.
• Supports research: By allowing for the use of large-scale, real-world data sets, interoperability helps the development of new treatments and technologies.

Health data interoperability is essential for creating a more connected and efficient healthcare system that focuses on patient wellbeing. Healthcare organizations that do not meet specific interoperability requirements may face financial penalties or reduced reimbursements. For example, in 2019, CMS finalized a rule that requires hospitals to share electronic patient data with other healthcare providers in a standard format in order to receive full Medicare reimbursements.

However, despite its importance and benefits, there are many challenges to achieving healthcare interoperability

Challenges to EHR Interoperability and Solutions

As we have seen, the main aim of healthcare interoperability is to allow for smooth sharing of health-related information between healthcare providers and patients to support clinical decision-making. Here are some of the challenges to achieving this goal and the solutions:

• Lack of standardization: While standard record formats such as FHIR and HL7 exist and regulatory requirements are leading EHR vendors to provide application programming interfaces (APIs) that enable interoperability, several healthcare providers and systems still rely on customized EHR systems that may be challenging to convert to a standard format and share with other providers. The development of application programming interfaces (APIs) that allow HIT systems to exchange data securely and efficiently can speed progress towards interoperability.

• Patient privacy concerns: With the growing prevalence of cybersecurity attacks on healthcare systems, healthcare organizations find it challenging to balance the accessibility of health information with the need to secure sensitive information and maintain patient privacy. Several healthcare providers may have systems that may not be compatible with new EHR products.

Given that even a single breach of PHI (protected health information) can result in significant fines and reputational harm, healthcare organizations need to have stringent measures in place to safeguard their patients’ information.

• Data management problems: Large healthcare networks often face challenges with inconsistent data, which can lead to healthcare IT providers spending hours searching for information stored by providers in various locations. Achieving healthcare interoperability requires managing EHR/EMR data, IoT data, internal hospital systems, and more, and any delays in addressing these issues can disrupt procedures.
   

  Effective integration technologies and healthcare analytics solutions can help improve interoperability and enable strong coordination across different organizations, regulators, and leaders. A unified network and interface can establish a standardized EHR network, while automating data extraction from multiple silos can help create a consistent dataset.

• Patient consent: Patient consent is a legal requirement and ethical practice in healthcare that ensures that patients have control over their health information. This means that healthcare providers cannot share a patient’s personal health information without their explicit permission, except in certain circumstances such as in emergency situations or when required by law.
   
  However, as IBM notes, the development of digital health systems that facilitate the seamless flow of health information between healthcare providers can create uncertainty about when patient consent is necessary and what level of consent is required. Healthcare organizations may be hesitant to share information and often focus on prioritizing safeguarding patient privacy and confidentiality, posing a challenge to interoperability.
   

  Healthcare providers must obtain informed consent from patients before sharing their health information across different healthcare systems. This ensures that patients are fully aware of what information will be shared, with whom, and for what purpose, and can make an informed decision about whether or not to share their health information.

• Financial constraints: Building EHR interoperability can require significant financial investments and ongoing maintenance costs. The cost of implementing and maintaining EHR systems can be significant as it includes not only the cost of the software and hardware but also the cost of staff training, system customization, and ongoing maintenance and upgrades. Furthermore, investing in technology and software solutions to enable data conversion and migration between different systems, can be costly and time-consuming.

Despite the many challenges for interoperability, solutions are available. With advances in cloud computing, especially hybrid cloud, it’s become easier for organizations to move and secure data in a consistent and standardized way. Cloud-based EHRs enable easy integration and access to various data sources, including clinical, lab, and pharmacy systems, ensuring interoperability and improving the quality of care for patients. These EHRs also allow for storing of data on multiple servers across different geographical locations, enabling retrieval of data as needed. They also come with advanced security features to protect against cyberattacks and unauthorized access to sensitive patient data.

As patient data is shared across healthcare systems and organizations, ensuring accuracy and timeliness in the information is crucial. Medical transcription companies can help healthcare providers maintain up-to-date and accurate EHR data to support clinical decision-making and patient care.