EHR adoption up, challenges in interoperability and meaningful use remain

For all of the enthusiasm around electronic health records (EHRs), the systems that providers have put in place are still limited in their effectiveness because, too often, they don’t talk to one another and only add to the administrative burden that they are intended to help reduce.

Those were among the complaints aired Tuesday at a Senate hearing considering the state of EHRs, the first in a planned series of meetings as lawmakers consider legislation to update the 2009 HITECH Act, which provided a roadmap for implementing the systems and developing standards.

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“The hope was that the program would improve care, coordination and reduce costs. The evidence suggests these goals haven’t been reached,” said Lamar Alexander (R-Tenn.), the chairman of the Senate health committee.

Interoperability on a 10-year plan

Interoperability has long been a challenge in the EHR space, and the Office of the National Coordinator (ONC) for Health IT recently issued a 10-year roadmap to address the issue in medical records and other systems and applications.

“An interoperable health IT ecosystem makes the right data available to the right people at the right time across products and organizations in a way that can be relied upon and meaningfully used by recipients,” the ONC said in its report (available in PDF format here).

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But the testimony of the witnesses at this week’s hearing made it clear that the vision of a fully interoperable records system is a long way from reality.

The most recent government figures indicate that 48 percent of physicians have adopted EHRs, while electronic records are in place at 59 percent of hospitals.

That marks a steep uptick in the years following the HITECH Act, which established the “meaningful use” certification process for EHRs. But Julia Adler-Milstein, an assistant professor of health management and policy at the University of Michigan, cites estimates that only between 20 percent and 30 percent of providers are using EHRs to communicate with physicians at other institutions.

“It may be surprising to discover that the true barriers to such exchange are largely not technical ones,” Adler-Milstein said.

“An agreed-upon set of standards, implemented in a consistent way, would undoubtedly facilitate interoperability, but the underlying issue is that we don’t have the incentives in place to make this a reality,” she added. “EHR vendors do not have a business case for seamless, affordable interoperability across vendor platforms, and provider organizations find it an expense that they often can’t justify.”

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Think tank outlines EHR complaints and meaningful use

Other complaints about the EHR rollout and meaningful use are detailed in a new report by the Brookings Institution, a Washington think tank. The authors of that paper (PDF) cited an unpublished survey conducted by the Association of Medical Directors of Information Systems, in which 0 percent of respondents said that their EHR system had helped cut costs or reduce the burden on staff.

Robert Wergin, president of the American Academy of Family Physicians, who has a practice in Milford, Neb., echoed that sentiment at Tuesday’s hearing.

“Four years ago my practice implemented an electronic health record, and I have to say it wasn’t pretty,” Wergin said. “Regulatory burdens are interfering with the doctor-patient relationship.”

The authors of the Brookings report suggest that lawmakers could tweak the meaningful use program and reporting requirements to focus on “outcome-oriented performance measures,” and call for increased efforts at setting standards for reporting patient information directly through EHRs.

Peter DeVault, director of interoperability at Epic Systems, an EHR provider based in Verona, Wis., argued that the ability of systems to communicate with one another is challenged by a variety of factors, including the absence of a strong legal framework to facilitate information sharing and a single, nationwide directory of providers and organizations that are able to exchange data on a common standard.

“Often I hear that the problem with interoperability is the lack of standards, and I would argue that that’s a minor problem compared to some of the others. We’ve had standards for several years now for being able to interoperate with some kinds of data,” DeVault said, calling for greater coordination across the ecosystem of vendors, providers and other organizations.

“In my opinion, it’s not a technological problem to create these standards,” he said. “It certainly does require the participation of at least a core group of vendors.”

He expressed concern that practices that have rolled out EHRs are having to devote more staff hours to technical and compliance issues that those systems entail, diverting already scarce resources away from treating patients. Adler-Milstein argued that too many EHRs require providers to log information that has very little to do with improving patient care, which creates both an administrative burden and a big data problem when too much superfluous information comingles with what’s actually relevant.

“I often hear physicians using the technical term ‘gobbledygook’ to describe the information that they find in the clinical notes fields of their EHR,” Adler-Milstein said. “They also express frustration with the amount of time they have to spend documenting information that’s not directly relevant to patient care. Simply put, the multitude of clinical, billing and regulatory requirements for what must be documented in the EHR is compromising the quality of the data in the EHR, and if the data isn’t good, simply having it be electronic isn’t going to get us anywhere.”