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Vaishali Patel, ONC Office of Planning, Evaluation and Analysis

Hospitals lead docs, patients in health information exchange

By Joseph Conn
Posted: August 6, 2014 - 3:15 pm ET

When it comes to the electronic exchange of health information, hospitals are far ahead of office-based physicians, who are well ahead of their patients, according to multiple surveys presented by the Office of the National Coordinator for Health Information Technology.

For example, the percentage of nongovernment hospitals that electronically exchanged lab test results, radiology reports, clinical-care summaries or medication lists with other hospitals or other providers outside their organizations rose from 41% in 2008 to 62% in 2013, according to a presentation delivered Wednesday to the federally chartered Health IT Policy Committee by Vaishali Patel, a senior adviser to the ONC's Office of Planning, Evaluation and Analysis.

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Among physicians, however, just 39% of them exchanged information with other providers in 2013, and only 14% performed those exchanges with providers outside of their organizations. Only 5% exchanged info with outside hospitals.

“The data show there is growth, but there is substantial room for improvement,” Patel told committee members.

In an interview after the meeting, Patel said the purpose of the multiple survey work was to monitor the progress of exchange as the federal electronic health-record incentive-payment program under the American Recovery and Reinvestment Act shifts gears from the Stage 1 meaningful use criteria to Stage 2.

“To date, most of our measurement activities have focused on health information exchange as opposed to interoperability,” which Patel differentiated as not just the swapping of information, but “the ability of EHRs to digest the information and parse it out and be able to use it for other purposes.”

“Most of Stage 1 really focuses on exchange, rather than the interoperability piece, which is Stage 2,” Patel said. “We do recognize we need to measure interoperability going forward,” she said. The ONC is busy now developing measures to do that.

Among hospitals surveyed in 2013 in an addendum to the annual American Hospital Association survey, 51% were able to electronically query patient data from another organization, while 41% were able to both send and receive patient information from external sources via secure messaging.

In a separate survey by the National Center for Health Statistics, physicians who exchange patient health information with other providers report it increases their practice efficiency—80% of those surveyed indicated that was so—and an even greater percentage (89%) responded that they believe it improves the quality of patient care. But 64% of physicians surveyed indicated exchange requires multiple systems or portals to do it while 38% complained it decreases their ability to separate sensitive health information from other data being exchanged.

Most commonly, physicians exchange lab information (36% reported they did), but about a third of them also reported exchanging medication lists, med allergy lists, problem lists and imaging reports.

There was far more variation in the types of information exchanged by hospitals, with labs topping the list in the 2013 survey at 57%; followed by radiology reports, 55%; clinical care summaries, 42%; and medication histories, 37%. In each category, the number of hospitals performing these types of exchanges increased by 12 to 18 percentage points since 2008.

In an ONC telephone survey of consumers in 2013, 28% of adult patients reported they'd been offered online access to their medical records. Of those who had online access made available, 46% took advantage of it and viewed their records online, 44% shared their information with another healthcare provider or family member, 39% downloaded their records, and 11% sent their data to a mobile application or a personal health record.

Patel also gave a status update based on reports from health information exchanges in 50 states and in Washington, D.C., funded by the ONC under the American Recovery and Reinvestment Act, which indicated a growth in their operations and functions.

By the 4th quarter of 2013, 90% of state HIEs had at least one operational health information service provider handling exchanges, compared with 59% of states in the 2nd quarter of 2012.

In keeping with a congressional mandate in the American Recovery and Reinvestment Act to promote interoperability of health IT systems, the ONC has funneled $564 million of stimulus law money through 50 states, the District of Columbia and various U.S. territories, according to the agency's web site.

Follow Joseph Conn on Twitter: @MHJConn

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