Data sharing: Why does it remain such a struggle?
Despite the widespread adoption of EHRs in recent years, data sharing between clinicians remains a struggle. In fact, a 2015 Commonwealth Fund International Health Policy Survey found that nearly 60% of all U.S. primary care providers were unable to electronically exchange patient clinical summaries with clinicians outside their practice. In other words, the majority of clinicians – and their patients – are still not realizing all the potential benefits of clinical data sharing, including better care coordination, a reduction in duplicative treatments and the reduced risk of medical error.
No simple answers
Why does the electronic sharing of clinical data still elude so many providers? Unfortunately, there’s no one simple answer, though we do know that the process needs to be easier and must provide information in a more intuitive format that benefits both the sending and receiving providers.
Consider how providers have typically shared clinical data in recent years. Physicians in an emergency department, for example, might go through the time-consuming process of calling a patient’s primary care provider or faxing a request for information in order to obtain a patient’s relevant health history. The history would then be manually keyed or scanned into the hospital’s system.
Providers must also regularly forward patient records to other providers. A referring doctor might give a patient a stack of paper records to hand the new provider or forward the records via fax. Again, the new provider must either manually key or scan the records into the practice’s EHR.
Obviously, this “old” way of pulling and pushing information is far from efficient. Fortunately, technology has evolved and providers now have a number of new solutions available. For example, Aprima offers data sharing through the Surescripts® National Record Locator service, as well as through CommonWell® Health Alliance. If two providers both have access to the same data sharing service, the new doctor can initiate an electronic query of the system, determine where else the patient has received healthcare services and request an electronic download of relevant records.
Aprima also supports Direct Messaging, which allows providers to share records securely online. Direct Messaging is a standardized protocol for exchanging clinical messages and attachments, and, under the Meaningful Use program, EHRs must have Direct Messaging capabilities for certification.
Despite relatively wide availability, however, providers continue to resist electronic data sharing.
The chicken and egg conundrum
Why are clinicians still not embracing electronic data sharing? Is it because they are unwilling to use the technology? Or, are they resisting adoption because too few other providers in their network are also sharing data electronically?
Consider the physician who is motivated to use Direct Messaging to share records with other providers. In order for record sharing to occur, both the sending and receiving clinicians must both be utilizing Direct Messaging. If one of the doctors is not, then records must be sent via fax or on paper. Thus even if a doctor is motivated to use Direct, he/she may abandon the technology if too few other providers are also using Direct.
CMS, which has long encouraged the electronic transmission of patient data, has responded to this chicken and egg conundrum by continually watering down data sharing requirements. For example, though the Direct Project was launched in 2010, 2016 is the first year that providers are required to demonstrate the use of Direct Messaging to meet objectives for the EHR Incentive Program.
Time for action
Until electronic data sharing is a requirement for the vast majority of clinicians, providers will continue to postpone adoption. Some health systems, as well as health IT vendors, will continue to stand in the way of data sharing in an attempt to protect their own self-interests. Ultimately, if we want widespread adoption, data sharing must be mandated.
We also need more standardization based on input from both the private and public sectors. The government needs to encourage the adoption of standards and to act as a facilitator to ensure adequate testing. Standards creation can be an overwhelming task and we must be careful not to slow the process by attempting to address every possible scenario and unique situation. Instead, we need to start with simple, common-use cases that satisfy the needs of a large number of providers and then build additional use cases over time.
If you are an Aprima client and not sharing data electronically with other providers, we’d love to help you make this transition. In addition to the Surescripts National Record Locator service and data sharing through CommonWell Health Alliance, our new Kno2™ fax solution provides an excellent migration path towards full Direct Messaging adoption, while also facilitating Direct Messaging adoption for other providers in your network.
Thanks to a variety of technology initiatives and government incentive programs, the electronic sharing of patient data is now a feasible option for all providers. In order to spur widespread adoption, we need additional policy updates and more standards, along with flexible and easy-to-use solutions. At Aprima, we remain committed to helping providers share data electronically with efficient solutions that enhance the care process.
You can read an article by Neil Simon on this topic, published by Health Management Technology, at https://www.healthmgttech.com/dread-data-sharing.
Neil Simon, Aprima COO