Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 3.4.2. Electronic HIE Capability

10/29/2013

While there has been a dramatic increase in the number of United States providers using HIT, expanding interoperability remains challenging, and requires further reducing the cost and complexity of electronic HIE, ensuring trust among the key participants of exchange, and encouraging exchange of information, particularly during transitions of care. ONC is playing a central role in enabling each of these key goals.28

The adoption of EHR/EMRs by LTPAC/LTSS providers could increase the likelihood that these providers will participate in electronic HIE and exchange standardized data to support care coordination. As HIE interoperability standards mature and LTPAC/LTSS and other providers adopt more sophisticated and interoperable HIT including EHRs, the potential for exchanging standardized information and ensure safe, high-quality care, will grow.

  • In 2012, of those hospitals that implemented an EHR, approximately 43% can generate a summary care record for transitions.97

  • Many hospitals are participating in HIE. Exchange between non-affiliated organizations and hospitals with different EHR solutions has recently increased. For example, one study found that in 2009 about 11% of hospitals exchanged data with non-affiliated providers through an HIEO in 2009.98 A more recent study based on a national hospital survey, found that in 2012, 58% of hospitals actively exchanged electronic health information with providers and hospitals outside their organization.93 Another study reported that EHR adoption and HIEO participation were associated with significantly greater hospital exchange activity.99

  • Market research suggests there will be significant investment in HIE in the next few years. A 2012 CapSite report found that 71% United States hospitals plan to purchase HIE tools.100

  • The 2011 National Ambulatory Medical Care Survey found that 29.4% of physicians electronically exchanged a patient clinical summary. Of these physicians, 64.2% used an EMR/EHR vendor, 27.5% used hospital-based systems, 19.5% used secure e-mail attachments, 15.1% used other mechanisms or unknown mechanisms, and 4.6% used HIOs or a state exchange. More than one method of exchange could be reported.93

  • In a recent study by the Bipartisan Policy Center, more than 70% of clinicians surveyed identified lack of interoperability, lack of an information exchange infrastructure, and the cost of setting up and maintaining interfaces and exchanges as a major barrier that prevents information exchange.101

  • The 2010 NSRCF found that of those residential care facilities that had implemented an EHR, nearly 25% of residential care facilities could exchange with pharmacies, and 17% could exchange with physicians.91

  • The 2010 NSRCF is the only national survey on EHR adoption and use by LTPAC providers that asks questions regarding HIE, and reports on the percentage of residential care facilities engaged in electronic HIE with the following health care providers or resources: pharmacies (8.2%), physicians (7.4%), corporate offices (5.6%), hospitals (5.4%), SNFs (4.7%), laboratories (4.4%), other health or long-term care providers (3.7%), resident's personal health records (3.4%), public health reporting (2.9%), and one or more specified providers (15.5%).93

HIEOs and LTPAC Provider Participation

The 2012 eHealth Initiative Annual Survey of HIE surveyed national, state, regional, enterprise, and community-based "initiatives" working on HIE. These initiatives are not specified, but included more than just HIEOs or HIOs. The respondents represented 50% of total known HIE initiative programs. Of the 161 HIEs initiatives that responded to the surveys, 26, or 16%, reported receiving LTPAC providers' data.6 It was not possible to identify the specific number or types of LTPAC providers engaged in HIE initiatives from the survey results. The 2013 and future survey results can track the growth in LTPAC participation in HIE initiatives.

A recent study based on a survey of HIEOs found that there were 119 operational HIEOs in 2012, an increase from 75 in 2010. Operational exchange was defined as the exchange of clinical data between independent entities (e.g., hospitals, laboratories, and payers). The study also found that 1,398 hospitals and 23,341 physician practices were using HIEOs for a variety of functions. Of the 119 operational HIEOs, around 25% reported that LTPAC providers participated by sending data, and 41% by receiving data. Test results (82%) and summary of care records (79%) were the most common exchanged information across all participants. Less than 25% of operational HIEs were found to be financially sustainable, and grants accounted for 52% of HIE efforts. The authors concluded that while more HIEOs are operational, business models do not yet support a viable future.102


 

6. eHealth Initiative. 2012 report on health information exchange: Supporting healthcare reform. Washington, DC: eHealth Initiative; 2012.

28. Office of the National Coordinator for Health Information Technology. Update on the adoption of health information technology and related efforts to facilitate the electronic use and exchange of health information. Washington, DC: Office of the National Coordinator for Health Information Technology; 2013.

  1. Decker SL, Jamoom EW, Sisk JE. Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems. Health Aff; 2012; 31(5): 1108-1114.

  2. Caffrey C, Park-Lee E. Use of electronic health records in residential care communities. Hyattsville, MD: National Center for Health Statistics; 2013; No. 128.

  3. National Center for Health Statistics. National study for long-term care providers, 2011. Available athttp://www.cdc.gov/nchs/data/nsltcp/NSLTCP_FS.pdf. Accessed August 20, 2013.

  4. Hsiao CJ, Hing E. Adoption of health information technology among U.S. ambulatory and long-term care providers. National Conference on Health Statistics. Washington, DC: 2012. Available at http://www.cdc.gov/nchs/ppt/nchs2012/SS-03_HSIAO.pdf. Accessed August 20, 2013.

  5. Richard A, Kaehny M, May K, et al. Literature review and synthesis: Existing surveys on health information technology, including surveys on health information technology in nursing homes and home health. Washington, DC: Office of the Assistant Secretary for Planning and Evaluation; 2009. Available at http://aspe.hhs.gov/daltcp/reports/2009/hitlitrev.htm#table2.

  6. Resnick HE, Alwan M. Use of health information technology in home health and hospice agencies: United States, 2007. J Am Med Inform Assoc; 2010; 17: 389-395.

  7. Wolf L, Harvell J, Jha AK. Hospitals ineligible for federal meaningful use incentives have dismally low rates of adoption of electronic health records. Health Aff; 2012; 31(3): 505-513.

  8. Desroches CM, Charles D, Furukawa MF, et al. Adoption of electronic health records grows rapidly, but fewer than half of US hospitals had at least a basic system in 2012. Health Aff (Millwood); 2013; 32(8): 1478-1485.

  9. Adler-Milstein J, DesRoches C, Jha A. Health information exchange among US hospitals. Am J Manag Care; 2011; 17: 761-768.

  10. Furukawa MF, Patel V, Charles D, et al. Hospital electronic health information exchange grew substantially in 2008-12. Health Aff (Millwood); 2013; 32(8): 1346-1354.

  11. CapSite. 2012 U.S. Health information exchange study. CapSite; 2012.

  12. Bipartisan Policy Center. Clinician perspectives on electronic health information sharing for transitions of care. Washington, DC: Bipartisan Policy Center; 2012.

  13. Adler-Milstein J, Bates DW, Jha AK. Operational health information exchanges show substantial growth, but long-term funding remains a concern. Health Aff (Millwood); 2013; 32(8): 1486-1492.

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