Data sharing between clinicians facilitates care coordination, reduces duplicative treatments, and minimizes the risk of costly mistakes. Despite these and numerous other benefits, nearly 60 percent of U.S. primary care providers (PCPs) are unable to electronically exchange patient clinical summaries with clinicians outside their practice, according to a 2015 Commonwealth Fund International Health Policy Survey.1
Why, despite the fact that 78 percent of physicians now use certified EHRs, does the electronic sharing of data between clinicians remain such a struggle?2 Undoubtedly, there’s no one simple answer, though contributing factors include the industry’s failure to:
- Make the exchange of data as easy as sending a fax or an email; and
- Develop solutions that deliver information in a format that is truly meaningful to the recipient.
To understand the situation better, first consider why and how physicians currently share clinical information.
Information pulling and pushing
In order to share clinical data, clinicians need the ability to pull information from other providers, as well as push information between other providers:
- Information pulling. When a patient shows up in an emergency department, providers typically seek to pull additional clinical information that provides a more complete picture of the patient’s health status. The patient or a family member may provide some of the history, or the ED might reach out to the patient’s primary care provider and request a faxed summary of the patient’s medications, allergies, and problems. Alternatively, if the ED and the PCP both have access to a data sharing service, such as Surescripts National Record Locator or CommonWell Health Alliance, the ED could electronically query the system, determine where else the patient received healthcare services, and request an electronic download of relevant records.
- Information pushing. When a patient is referred from one provider to another, the referring physician will push out clinical information that helps the new doctor assess the patient’s health. Providers may fax or mail these records, or use Direct Messaging to forward 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.
Most clinicians already have access to technologies that facilitate data exchange between other providers. However, until more clinicians adopt – and utilize – these technologies, the electronic sharing of data will not be ubiquitous.
The chicken and egg conundrum
Are clinicians not sharing data electronically because they are unwilling to use the technology, or are they unwilling to use the technology because too few providers in their network are available to share 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, 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.
At the same time, we need to improve the technology so that it offers real value to providers. Clinicians using certified EHRs have the capabilities they need already built into their systems. However, the format for transmitted records needs to be streamlined so physicians can easily identify the patient’s relevant issues. Extraneous information needs to be eliminated so that the care process is optimized.
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. 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.
Building on success
Thanks to a variety of technology initiatives and government incentive programs, we’ve proven that electronic sharing of patient data between providers is feasible. Now it’s time to build on this early success and address both the policy changes and technological advancements required to spark widespread adoption.
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