Health IT infrastructure has made significant progress in recent years, with EHR adoption among hospitals and physicians growing. However, the development of health information exchanges and interoperability – needed  to provide more effective care – still has a long way to go.

These findings in the annual report to Congress from the Office of the National Coordinator for Health Information Technology show decidedly mixed results, outlining steady adoption of many of the goals set out by the HITECH Act of 2009, while not yet achieving the interoperability that could leverage health technologies to transform care.

“This progress has laid a strong base for health IT adoption and created a growing demand for interoperability that not only supports the care continuum, but also supports health generally,” ONC explained in the report.

As an example of what has been accomplished, the report showed that in 2013, 59 percent of hospitals and 48 percent of physicians had at least a basic EHR system — respective increases of 47 percentage points and 26 percentage points since HITECH became law. And hospitals and professionals are increasingly participating in the CMS EHR Incentive Programs. As of June 2014, 75 percent (403,000) of the nation’s eligible professionals and 92 percent (4,500) of eligible hospitals and CAHs had received incentive payments.

ONC acknowledged some of the limits thus far.

“Electronic health information is not yet sufficiently standardized to allow seamless interoperability, as it is still inconsistently expressed through technical and medical vocabulary, structure, and format, thereby limiting the potential uses of the information to improve health and care,” ONC wrote.

The report gives causes for optimism, outlining the continuing development of HIEs in every healthcare setting.

[See also: DeSalvo: Interoperability 'top priority'.]

Among physicians
The ONC report said that in 2013, 69 percent of physicians reported the capability to order lab tests electronically and 77 percent reported they can view lab results electronically. In addition, 42 percent provide patients the capability to view online, download, or transmit information from their medical record, a requirement for Stage 2 of meaningful use.

Also, there have been significant increases in e-prescribing among healthcare providers. Fifty-seven percent of new and renewal prescriptions sent by physicians in 2013 were sent electronically, a fourteen-fold increase since 2008. Moreover, in 2013, 70 percent of providers use an EHR to e-prescribe on the Surescripts Network, up 63 percent since 2008. The proportion of the nation’s community pharmacies actively e-prescribing on the Surescripts Network grew from 76 percent in 2008 to 96 percent in 2013, an increase of 20 percentage points.

Among hospitals
More than half of hospitals electronically shared radiology reports (55 percent) and laboratory results (57 percent) with providers outside their system, according to the report. In addition, more than one-third of hospitals electronically shared clinical care summaries (42 percent) and medication lists (37 percent), a 68 percent increase in the exchange of clinical care summaries and 76 percent increase in the exchange of medication lists since 2008.

Hospitals shared information using a variety of mechanisms. Forty-one percent send and receive secure electronic messages containing patients health information outside their system. And half of all hospitals reported the capability for their providers to electronically query patient health information from sources outside their system

Remaining roadblocks
The report said that despite this progress, gaps remain for widespread use of interoperable systems and HIE.

“There is even more limited HIE involving post-acute and institutional long-term care, most behavioral health, and laboratory providers who are not eligible for incentive payments under the EHR Incentive Programs,” the report said. “Close to 40 percent of Medicare beneficiaries discharged from acute care hospitals are discharged to post-acute care settings, like rehabilitation hospitals and skilled nursing facilities, but there is little capacity in the system today to support HIE across these settings. Additionally, the infrastructure for an HIE is primarily high-speed Internet service, which is not readily available in all rural areas.”

[See also: Lack of interoperability stalls progress.] and [Interoperability: supply and demand.]

The report said communication lapses continue at hospitals due to reasons besides technological capability, such as organizational culture and provider workflow.

For example, 41 percent of hospitals provide electronic notification to a patient’s primary care provider when the patient enters the emergency department, but just 24 percent provide it outside their system. In 2013, only 14 percent of physicians shared patient information with any providers outside their organization.

ONC has been working on a 10-year roadmap to interoperability as well as the next iteration of its Federal Health IT Strategic Plan, which national coordinator Karen DeSalvo, MD, said present opportunities “to look at HIT beyond the EHR and policy levers beyond meaningful use.” The office intends to share a preview of its roadmap at next week’s joint meeting between the HIT policy and standards committees and discuss the strategic plan in December.

“Patient electronic health information needs to be available for appropriate use in solving major challenges,” ONC added, “such as providing more effective care and informing and accelerating scientific research.”