Addressing healthcare’s interoperability EHR challenges beyond the hospital

Much of the conversation around healthcare data interoperability focuses on improving information exchange among hospitals and health systems and allowing patients to obtain their records under the Cures Act Final Rule. Both initiatives are important, but they can overshadow another critical interoperability need as patient care transitions from traditional settings.

McKinsey estimates that a hospital’s share of overall provider revenue will drop from 47% in 2019 to 44% in 2025. At the same time, 84% of patients have used telehealth at least once in the last year, while one-third of Americans use retail clinics.

There are obvious benefits to this shift. With the cost of employer-sponsored plans expected to rise 5.6% in 2023, patients and plan sponsors alike will continue to look for low-cost care options. Convenience also allows patients to be seen quickly, theoretically reducing the utilization of high-acuity services for low-acuity care needs. Unfortunately, this shift presents interoperability challenges that, left unaddressed, can outweigh the positives.

Related story: How TEFCA aims to change the face of health data interoperability

At first glance, retail clinics seem better positioned. Leading providers CVS, Walgreens, and Walmart have adopted the Epic electronic health record system, the EHR of choice for acute care. After all, research has shown that facilities using the same vendor are more likely to be able to share data than those that don’t.

However, one-third of commonly shared data types (medications and lab tests) are nonetheless not “understood” by a receiving site when two sites share a vendor. When sites don’t share a vendor – which could easily be the case with ambulatory care, a market led by athenahealth – the percentage of data types not “understood” jumps to 78%. This contributes to duplicate labs tests or undocumented drug-drug interactions, which lead to increased costs and adverse outcomes.

Telehealth’s interoperability obstacles mirror those of competing EHR systems. The wide range of data types generated during a patient encounter – whether it’s structured data such as diagnostic codes or unstructured data such as clinical notes – rarely sync automatically from a telehealth platform to an EHR, forcing providers to enter the same information into two systems. Clinicians based at brick-and-mortar facilities can receive records of telehealth encounters in the Consolidated Clinical Document Architecture format, but as CCDA records require manual review, many go unread in the interest of time.

It’s clear that momentum is building to improve interoperability in healthcare. Now that the Trusted Exchange Framework and Common Agreement is in place, organizations are getting a gentle nudge to share data as part of a larger strategy to coordinate care. In addition, wider adoption of application programming interfaces based on the Fast Healthcare Interoperability Resources standard better enables EHRs from different vendors to share data types and not just static records.

As these efforts continue, and as patients’ preferred venues of care continue to shift, it will be critical for hospitals and health systems to include retail clinics and telehealth providers in their interoperability strategies.

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.