A majority of physicians now say that a business case for the electronic exchange of health information across all care settings is becoming evident because they believe it will have a positive impact on healthcare.

The recognition of the need for health information exchange is arising in part because it is an essential element in stage 2 of the meaningful use of electronic health records (EHRs) and in many of the payment system reforms that are being tested, according to former Sen. Bill Frist, MD, who was previously Senate majority leader, and is now co-leader of the health project at the Bipartisan Policy Center, at an Oct. 3 briefing.

Now that physicians are adopting EHRs, electronically sharing health information is the next logical step to improve patient care. But major hurdles block the exchange of health data.

“An overwhelming majority of more than 70 percent clinicians surveyed believe that the lack of interoperability and exchange infrastructure and the cost associated with those are major barriers to realizing this. Stage 2 of meaningful use in 2014 lays the foundation for increased interoperability of exchanges, particularly related to transitions of care,” Frist said.

The center released two companion reports on “Clinician Perspectives on Electronic Health Information Sharing for Transitions of Care” and “Accelerating Electronic Information Sharing to Improve Quality and Reduce Costs in Health Care.” 

Dr. Farzad Mostashari, the national health IT coordinator, said that the report reflects the views he has heard in meeting with physicians across the country on health information exchange.

“The report, the way it starts off, the first finding is dead-on, in terms of the centrality of every conversation we’re having, that a business case is emerging,” he said at the briefing.

According to the survey, physicians also would like to have a standard set of information shared with them when a patient is discharged from a hospital or changes in other care settings and to be able to query for other data.  

The survey polled clinicians about their needs and preferences regarding electronic health information: what type of information they want in various care transitions and how quickly.

Relevant lab and imaging tests ranked high among all physicians as the type of information they want across the board. But other data, like discharge summary, reason for referral and summary of care provided, are critical across transitions, said Janet Marchibroda, chair of the center’s health IT initiative and long-time health IT expert.

When it came to how they wanted to receive data, more than one half of the physicians surveyed said “push to me, send me only the essential data. Give me the ability to query the rest,” she said.

Most of the polled physicians said they preferred to selectively pick the information they want to integrate into the patient’s electronic record.

Timeliness was also important. A majority said 24 hours was a reasonable time for the exchange of information when a patient requires follow-up care or being treated for an urgent problem. “That [exchange] doesn’t happen very often today,” she added.

Among the recommendations to accelerate exchange is to develop a national strategy and long-term plan for standards and interoperability, Frist said, adding that “unless there is clarity there, there is chaos and confusion.”

Marchibroda noted that the federal advisory Health IT Policy and Standards committees were moving forward a lot of the standards and interoperability work, but it is primarily focused on meaningful use, such as for data transport standards.

“We need to pull people together around data, standards and interoperability beyond meaningful use,” she said. For example, primary care providers, specialists and hospitals need to get agreement on information for clinical decision support that makes sense for all of them.

Other proposals to hasten interoperability included:

• Collaboration among primary care providers, specialists and hospitals to define and agree on what they need to share in transitions of care
• More and better guidance from the federal government, including for query models for exchange that could be accomplished by clarifications in regulation FAQs
• A national strategy of improving the accuracy of matching patient data across settings, such as identifiers decided voluntarily by an individual
• Exceptions and safe harbors to navigate the legal barriers of current laws that did not anticipate sharing information
• More guidance and clarity on privacy and security, considering variations in state laws, and developing some standards around models for consent.

The survey was done by the Bipartisan Policy Center in coordination with Doctors Helping Doctors Transform Health Care, a collaborative effort led primarily by doctors, for doctors, to support the transformation of health care through health IT, and the American College of Physicians, the largest medical-specialty organization. The second report was the center’s findings and recommendations for accelerating health information exchange and which was informed by the survey of physicians.