Physician Capability to Electronically Exchange Clinical Information, 2011 | Page 4
Published Online: October 23, 2013
Vaishali Patel, PhD, MPH; Matthew J. Swain, MPH; Jennifer King, PhD; and Michael F. Furukawa, PhD
However, our findings indicate that EHR systems do not all offer equivalent exchange capability. Although most physicians with EHRs reported capability to e-prescribe and view laboratory results, we found wide variation across EHR vendors in capabilities for lab ordering and exchange of clinical summaries. This variation may be due to how recently the physician implemented the EHR and whether the product met certification criteria requiring it to support clinical summary exchange. Some EHR vendors have designed products using outdated technology that does not enable interoperability with other systems.24 Variation in HIE capability across vendors may diminish over time as physicians upgrade their systems or purchase newer systems that meet more rigorousstage 2 meaningful use certification criteria related to HIE. The requirement to demonstrate the capability to exchange clinical summaries across different vendor platforms may increase the number of vendors offering products featuring this functionality, paving the way for an increase in the proportion of physicians using EHRs to exchange clinical care summaries with other providers. Evidence suggests that after the implementation of stage 1 meaningful use requiring physicians to e-prescribe, the proportion of providers e-prescribing on the Surescripts network using an EHR increased almost 7-fold from 7% in 2008 to 48% in 2012.25
Another potential driver of HIE is healthcare payment and delivery reform. As payment and organization continues to evolve, rewarding providers who better manage patient populations and penalizing those that do not will likely spur demand for HIE and the ability to facilitate transitions in care electronically.26 Specifically, accountable care organizations, which allow entities to share cost savings, may create a business case for HIE by giving providers greater financial incentives to exchange information regarding their patients with each other. Additionally, financial penalties for high hospital readmission rates, for example, may spur greater care coordination between hospitals and ambulatory care providers to better manage transitions of care through the use of care summaries.27,28
Physician exchange capability also varied widely across states. Prior state health information technology investment, state legislation and regulations, and existing local/regional health information organizations may help explain some of this variation.29 Furthermore, variation in EHR adoption rates may also explain these differences. Except for Vermont, all the states with above-average (relative to national) exchange capability (across multiple measures) also have significantly higher levels of EHR adoption.30 Understanding how states such as Minnesota have facilitated higher rates of physician exchange capability across a number of measures may provide other states with best practices in promoting greater exchange activity. These findings suggest that ONC's State HIE program has an important role in ensuring that physicians, regardless of their geographic location, have the capability to exchange clinical information with patients and other providers. The measures examined as part of this baseline study of exchange capability are being used by the State HIE program to monitor the performance of states and set national goals.15
In addition to EHR use, other physician and practice characteristics were associated with greater exchange capability. However, these were not as strong predictors as EHR adoption, nor were the patterns necessarily consistent across the different types of clinical data. Smaller practices have previously reported experiencing barriers to HIE, and our findings suggest that smaller practices do have less capability to exchange with pharmacies and laboratories compared with larger practices; however, we did not find differences with regard to clinical summary exchange.31 Primary care physicians’ higher rates of exchange capability compared with specialists—which persisted after controlling for EHR use—may be driven in part by primary care physicians’ greater need to exchange information with other providers to coordinate and manage their patients care.28
This study has some important limitations. These findings are based on self-reported survey data, which could not be independently verified. The survey did not capture detail on all mechanisms or tools by which physicians may exchange clinical information, including stand-alone systems or proprietary portals. Our measure of pharmacy exchange was limited; the survey did not capture potential exchange from the pharmacy or pharmacy benefit manager such as prescription renewals, eligibility/formulary verification, and medication histories.32 Nor did the survey report on whether physicians exchanged information with providers outside their practice or organization. We were also not able to measure physicians’ capability to exchange data across different EHR vendor platforms, which is required for stage 2 meaningful use. In addition to examining trends in exchange capability, future research should examine physicians’ actual use of exchange functionality.33
This baseline study of physician capability to exchange key types of clinical information found room for improvement but also a foundation on which to build and expand physician exchange capability. Our findings suggest that while most physicians possess the capability to meet certain HIE-related meaningful use requirements such as e-prescribing, physicians are less prepared to meet other upcoming stage 2 core HIE requirements such as clinical care summary exchange. It will be important to monitor these key measures of exchange capability as ambulatory providers implement EHRs meeting meaningful use stage 2 requirements and as shifts in healthcare delivery require robust exchange of health information.
Author Affiliations: From Office of the National Coordinator for Health Information Technology (VP, MJS, JK, MFF), US Department of Health and Human Services, Washington, DC.
Funding Source: None.
Author Disclosures: The authors (VP, MJS, JK, MFF) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.
Authorship Information: Concept and design (VP, MJS, JK, MFF); acquisition of data (VP); analysis and interpretation of data (VP, MJS, JK, MFF); drafting of the manuscript (VP, MJS, MFF); critical revision of the manuscript for important intellectual content (VP, MJS, JK, MFF); statistical analysis (JK, MFF); and supervision (MFF).
Address correspondence to: Vaishali Patel, PhD, MPH, Senior Advisor, Office of Economic Analysis Evaluation and Modeling Office of the National Coordinator for Health Information Technology, 200 Independence Ave SW, Washington, DC 20201. E-mail: firstname.lastname@example.org.
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