Experts Question Efficacy of Current Data Exchange Practices

April 23, 2015 in News

While data show that electronic health information sharing has increased in recent years, some industry experts question the usefulness of the data being transmitted, Modern Healthcare reports.

Increase in Electronic Data Exchange

According to electronic health record vendor data provided to Modern Healthcare, vendors’ clients have increasingly shared summaries of patients’ EHR data through the Consolidated Clinical Document Architecture standard. The summary, which can help fulfil transitions of care requirements under the meaningful use program, can include data such as patients’:

  • Allergies;
  • Drugs; and
  • Problem lists.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments.

For example:

  • athenahealth clients sent about 117,000 C-CDA documents in the first quarter of 2015 to non-athenahealth systems, compared with 108,000 documents throughout all of last year;
  • Cerner clients sent about 7.3 million C-CDA documents in March — more than half of which were sent to non-Cerner systems — compared with 4.3 million documents in July 2014;
  • eClinicalWorks clients sent about 550,000 more documents in the first quarter of 2015, compared with its quarterly average in 2014;
  • Epic clients exchanged about 10.2 million C-CDA documents in March — including 1.36 million that were sent to non- Epic systems — compared with 4.6 million documents in July 2014, which included 480,000 outside exchanges; and
  • Greenway Health clients sent 82% more documents in March 2015, compared with September 2014.

In addition, an analysis by the Office of the National Coordinator for Health IT that used data from the American Hospital Association’s annual hospital survey found that 76% of hospitals sent some form of data to a provider outside their organization last year, compared with 62% in 2013.

Data Caveats, Concerns

However, some industry experts cautioned that such data require crucial context.

University of Michigan health IT researcher Julia Adler-Milstein said that the data do not indicate how many visits resulted in data exchange or how much of the data is useful to providers.

Some experts say that recipients of C-CDA documents often find the data unhelpful, resulting in the information being unused or underused. They cited several examples, including that C-CDA data are:

  • Too voluminous, with some providers sending more information than necessary to ensure they meet requirements under the meaningful use program;
  • Not always tailored to meet the specific needs of patients or providers; and
  • Not computable, only allowing providers to see the entire data set in a view-only format.

In addition, some experts said that the standards governing C-CDA documents are vague, leading to issues such as variability in how certain drugs are denoted in the documents.

Potential Solutions

Industry experts said that data exchange could be improved by allowing providers to request specific sets of data — such as current allergy or medication lists — rather than receiving the entire electronic patient record.

CommonWell Health Alliance Executive Director Jitin Asnaani said that the alliance intends to allow providers to pull specific data sets at a low cost as part of its efforts to expand interoperability.

In addition, Asnaani said that the increasing prevalence of value-based payment arrangements would help to promote better data sharing practices, in part because physicians will increasingly request more useful data (Tahir, Modern Healthcare, 4/22).

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