It's easy to find condemnations of the lack of electronic data-sharing between providers these days. Take the Epocrates survey (PDF) released just before this year's Healthcare Information and Management Systems Society conference: Only 14% of the 2,922 doctors surveyed gave the industry a “B” or above for its data-sharing practices.
And yet, based on vendor data, data-sharing is on the upswing. Despite the increase, though, experts believe the industry has a long way to go to achieve the level of exchange needed to support care coordination and consumer engagement. The problem is the usefulness of the information that's being shared. The goal isn't merely to push digital paper back and forth, but to exchange useful data.
One aspect of data-sharing is the C-CDA standard, or Consolidated Clinical Document Architecture. The standard sends along a summary of a patient's electronic health-record data, such as allergies, medications and a problem list. It can be used to fulfill the federal requirements for the meaningful use of EHRs regarding transitions of care, which mandate that providers send along data when patients are sent to another provider.
More of those documents are sent than ever before, according to data that vendors shared with Modern Healthcare. Epic Systems Corp. went from exchanging 4.6 million documents in July 2014, with 480,000 documents outside the Epic ecosystem, to roughly 10.2 million in March, including 1.36 million outside. The outside data exchange includes non-Epic EHRs, health information exchanges, and the eHealth Exchange, which includes the health systems for the Defense and Veterans Affairs departments.
Other EHR systems show similar growth. Cerner Corp. sent 7.3 million during March, up from 4.3 million in July. The vendor's vice president of interoperability, Bob Robke, estimates that “well over half” of those documents “are consumed by non-Cerner systems.”
Athenahealth customers, meanwhile, sent more C-CDA documents directly to other doctors in the first quarter of 2015 (roughly 117,000) than in all of 2014 (108,000).
Greenway Health, which focuses on physician practices and other ambulatory settings, said its clients posted 82% more transactions in March 2015 than last September. And eClinicalWorks, which likewise concentrates on the ambulatory market, exchanged roughly 550,000 more documents during the first quarter this year than their quarterly average last year.
The vendors' statistics are corroborated by a recent analysis (PDF) by the Office of the National Coordinator for Health Information Technology. Based on the American Hospital Association's annual hospital survey, 76% of hospitals exchanged at least some type of data outside their organization during 2014, compared with 62% the year before.
But Julia Adler-Milstein, a health IT researcher at the University of Michigan, said it's likely that much of the growth in data exchange reflects information transmitted from providers to health information exchanges, while the growth in provider-to-provider exchange is probably still modest.
And C-CDA exchange numbers don't tell the whole story, she cautioned. The figures leave out what she termed “the denominator”: The number of visits that generate the sharing. Nor do the numbers convey how much of the information is useful.
Cerner's Robke agreed. Asking about the number of C-CDA exchanges, he said, is like asking, “How many e-mails did you send today?” The answer says nothing about the value of the communication.
“In reality, what matters is how many people read the e-mails you sent yesterday,” Robke said, and it's harder for vendors to tell how much the data is actually used.
Many experts believe that C-CDA transmissions are often unused or underused because the information in them isn't helpful to recipients.