How HIEs Find Their Position of Strength in Ambulatory Data Exchange
In a recent webinar to the members of the Strategic Health Information Exchange Collaborative (SHIEC), our own Marilee Benson had the opportunity to lead a discussion on how HIEs can find their position of strength – truly become leaders – in ambulatory clinical data exchange.
Core to the strategy for becoming a leader in ambulatory data exchange is understanding current interoperability gaps and performing periodic assessments of the HIEs last-mile readiness.
Part 1 – Common Interoperability Gaps
The first major interoperability gap is a direct result of a perception problem. Regulations and guidelines for initiatives such as Meaningful Use have set historic benchmarks for what is minimally acceptable for clinical data exchange. However, there are significant differences in data sharing capabilities between versions of such regulations.
For instance, electronic health record (EHR) vendors who have successfully earned Meaningful Use attestation may have very different data sharing abilities depending on if they are Meaningful Use certified under 2011 standards, 2014 standards, or 2015 standards. The abilities tested and implemented under 2015 are far superior to the interoperability features of 2014 and 2011. Unfortunately, the numbers of technology vendors who have invested in the ongoing certifications have reduced greatly with each new version of the Meaningful Use criteria. Per November 2017 MU Attestation Data, about 800 products were certified under the 2014 criteria while only about 140 products – just 17.5% of the 800 have invested in the 2015 criteria. Just this week (July 13th), CMS announced that for the Promoting Interoperability performance category, CMS is requiring that MIPS-eligible clinicians use 2015 Edition certified EHR technology beginning with the 2019 MIPS performance period, thus we do expect to see an uptick in the number of in 2015 certified vendors.
What does this mean for HIEs seeking to become leaders in ambulatory interoperability? HIEs should investigate which of the common EHRs in their provider community have achieved the more advanced levels of interoperability certification – not assuming that any Meaningful Use certification badge will result in the ability to successfully exchange clinical data.
The second interoperability gap present in nearly every healthcare community is the gap in clinical data sharing possible between care settings.
There are at least four major care settings for which interoperability standards offered by Meaningful Use do not apply. Organizations using specialized EHRs and health information systems (HIS) for behavioral health, long-term care, treatment facilities, and short-term rehabilitation centers are likely to not have gone through the Meaningful Use initiatives. The incentives for such organizations either did not exist or their patient population was representative of those for whom incentives were offered.
What does this mean for HIEs seeking to become leaders in ambulatory interoperability? For HIEs to be able to offer the most complete view of a patient’s’ history, information from these care settings is vital. Whether for ambulatory encounters or in-patient encounters, clinical information must be presented. Unfortunately, technology solutions in this space may be behind in the ability to exchange clinical information with others because interoperability standards present in Meaningful Use initiatives were not pursued.
