By Anastasia Gnezditskaia
The COVID-19 pandemic has put in the spotlight the need to exchange health information across federal, state, and private systems. Such exchange remains a challenge, especially with electronic medical record systems (EMRs), forcing clinicians to spend a significant part of their time on administrative tasks.
According to 2021 research from Wakefield and Olive, 36% of clinicians spent more than half their day on administrative tasks and 72% expected this amount to increase over the next 12 months.
Added to that, only 24% of physicians surveyed among those enrolled in different EHR platforms said they have no problem sharing patient data with a provider using a different EHR, according to a physician sentiment survey done by AthenaHealth earlier this year.
And, in terms of sentiment, 80% of respondents among physicians said that the inability to share data across different systems causes them stress. Based on other similar survey by Wakefield, 40% of patients have had a healthcare professional not know what medications other healthcare providers had prescribed due to a lack of access to patient information.
All of this has to do with healthcare data fragmentation – fragmentation of markets, vendors, technologies, and policies.
Issues with healthcare exchange caused by the lack of interoperability between vendors impact healthcare practices in three crucial areas – transitions of care and referrals, orders and plans for care approval, and record requests and release of information.
Fragmentation of the electronical medical records’ market in these areas means that up to 25% of US health system spending may be considered waste in the light of information breakdowns, according to a recent JAMA report.
Interop issues in hospital acquisitions
Apart from affecting clinicians’ day-to-day lives, the issues of data compatibility also emerge during acquisition deals for hospitals and during post-M&A integration. In fact, many systems lack interoperability post-acquisition.
Those health systems that are based on the most prevalent in the market EHR vendor Epic tend to include their acquired companies into the Epic orbit when conducting M&A with a “more aggressive integration plan,” says Nathan Ray, a partner at West Monroe who works on M&A deals in healthcare and life sciences. At the same time, those based on the second most popular EHR system Cerner, tend to stay more fragmented within the system, without necessarily integrating the acquired company into Cerner, Ray said.
In addition, during market consolidation, smaller, single-specialty platforms in the areas such as gastroenterology or oncology tend to stay fragmented within the same health system in terms of EHR vendors that they use.
When integrating acquired companies into Epic or any other medical record providers, health systems face challenges related to the scarcity of IT resources, says Ray. Health systems do not have as many IT resources dedicated to interoperability and digital transformation as they do to areas such as IT security. Hospitals are frequently not aware of new technologies that come to market to help integrate health records. Due to that, when integrating companies into their EHR system, they have to attract third-party consultants to help along the integration path.
The scarcity of people focused on interop issues is a “big impediment for rapid interop change,” he said. Due to this, there is a high demand for third-party interoperability consultants.
Data vendors and their incentives
The current market is divided among a handful of EMR vendors. In terms of hospital market share, Epic controls 32.9%, Cerner 24.4%, Meditech 16.7%, CPSI 8.7%, Allscripts 4.3% and Medhost 3.1%.
With revenue predicted to reach $33.41 billion by 2025, this market remains highly fragmented. This means that while most medical records companies offer interoperability for customers within their ecosystem, many build their software to work smoothly within their system only.
In terms of incentives to make data flows and software more compatible, data interoperability for hospitals and EMR vendors is limited by two factors – HIPAA privacy laws and competitive dynamics, according to the RockHealth report.
Another interop impediment is data quality, which varies significantly across the systems and stands in the way of a smooth transition. Conflicting information, incomplete forms, the differences in formatting can impair the process of sharing patient records.
Executive director at Blue Spoon Consulting John Singer believes that to make systems more compatible with each other one needs to redesign the market, and what is needed to be addressed is “market interoperability, not data interoperability. The former is strategic, the latter operational,” he said.
“We’ve reached the point where we already have all the technological capability we need to create ‘on-demand’ health infrastructures that are ‘interoperable’ as an initial condition, versus trying to add-on after the fact.”
Apart from barriers, are there any incentives that motivate EMR vendors to make data flows and software more compatible?
Chief platform architect at digital therapeutics company BehaVR Patrick Murta believes that there are such incentives, one being regulatory, as EMR vendors can continue on the path of using HL7 Fast Health Interoperability Resources (FHIR) standards-based interoperability.
“This approach allows all participants in the healthcare ecosystem to securely share information using agreed upon standards,” he said.
In addition, the federal regulations under the ONC Cures Act rule provided a regulatory floor for medical records providers to use the technology. “Also, there is has been much work in the HL7 community with a group such as Da Vinci, Argonaut, and Carin to develop common implementation guides. Creation and implementation of these should continue, perhaps even accelerate,” said Murta.
Apart from regulatory, EMR vendors will face more and more market-based incentives down the road. “This would probably be more focused on provider reimbursement enhancements which then incents EMRs to move forward. As providers recognize that this type of interoperability removes the cost and improves outcomes both financially and clinically, they will push EMRs to move forward.”
“Also, since FHIR is closely associated with the value-based care model, for example, HL7 Da Vinci for outcomes optimization, that will provide additional incentives for EMRs as providers push for it.”
The role of digital health platforms
Despite all those realities that stand in the way of data interoperability, new digital platforms can go a long way towards helping to transition the healthcare data from one platform to another.
The funding for US-based health data infrastructure and interoperability startups reached $2.2 billion in 2021, up nearly three times from $736 million raised in 2020, according to a report by RockHealth.
Patient-care-focused interoperability players can be divided into two groups, according to the report. One is data access and exchange, or streamlining data transfers between providers, patients and other players. The other is about data integration, or including data from different technologies into information platforms based on which care decisions are made.
Can this digital health infrastructure make a difference in solving interop issues?
At West Monroe, Nathan Ray says new digital platforms such as Redox make a huge difference for M&A interop and data transfer compared to five years ago, but not many within health organizations are aware of those tools. Redox was launched to help healthcare clients with EHR integration and connecting data.
Singer believes that since interop is a system-level problem it requires a system-level solution. Healthcare systems need to be launched with the idea of being not standalone entities, but part of the health ecosystem. Currently, “there are too many platforms, too many point solutions wandering the edges,” said Singer.
“Technology is like a jungle in fast-forward motion. The challenge is how do you get in front of it and give it direction, rather than consistently follow?”