Challenges and Opportunities of Interoperability

March 28, 2014

A recent study from the Government Accountability Office (GAO) indicates that a lack of care coordination “can lead to inappropriate or duplicative tests and procedures that  increase health care spending” that can range from $148 billion to $226 billion per year.  The critical ability of health systems, networks and devices to exchange patient data is the elusive link in achieving coordinated care through a truly interconnected healthcare system, so why has interoperability escaped us thus far?

To date, the ability to share information electronically across provider organizations, vendors and geographies has been unattainable, despite the federal government’s incentives tied to Meaningful Use.  The first challenge is to increase the number of providers using electronic health records (EHRs).  While adoption is occurring, it is not consistent or widespread.  According to the GAO, EHR adoption has increased from 10% to nearly 50% over the past 10 years.  But, low adoption rates among specific demographics (namely, small physician groups, as well as small, rural, and nonteaching hospitals), as well as EHRs that are not interoperable and are difficult to use, have led to continued challenges in information sharing.

The adoption and use of EHRs offers a glimpse into some of the challenges that exist. Successful implementation of EHRs requires technology resources, training, behavior change from providers, and, of course, a financial investment.  The process from start to finish can take months or years.  Based on Surescripts’ analysis of public use files from and, more than 323,000 physicians and hospitals have adopted EHRs and attested as meaningful users of EHR applications as of fall 2013.  This 266% increase over the previous year represents a significant leap over the first hurdle to achieving full exchange of patient information.  Once the tipping point for EHR adoption is reached, clinicians should be able to exchange information with other providers to enhance care coordination, improve care and reduce costs.  Yet some researchers suggest that as few as 30 percent of hospitals and 10 percent of ambulatory practices currently participate in health information exchange.  Achieving broad health information exchange will not only require more hospitals and practices to implement EHRs, but doctors must also be able to share them with one another.

Surescripts is working to overcome a second challenge: the process of identifying and retrieving patient records that are housed in disparate systems.  Often times, patients visit multiple providers, need care while traveling, or have to obtain their medical history from several years back.  These factors, while seemingly straightforward, can represent significant problems in getting a full view of a patient’s medical history.  Today, identifying and locating patient records, sharing patient records with other hospitals and physicians, and obtaining a comprehensive view of a patient’s medical history is incredibly time consuming and resource intensive.

Surescripts is committed to playing an integral role in the way information is exchanged by continuing to expand and improve the reach of our network and the breadth of services offered.  To address the second hurdle, we recently launched our Record Locator and Exchange service that identifies patient records, leveraging a robust Master Patient Index of more than 210 million individuals, to facilitate the exchange of information with the requesting care provider’s EHR. Our Record Locator and Exchange service will help disparate providers find and share the information they need to provide informed care for patients.  To learn more about the benefits of our Record Locator and Exchange service, check out our whitepaper.

At the same time, Surescripts joined Carequality as a founding member.  Carequality is a new industry-led collaborative that is bringing together providers, vendors, payers and other stakeholders to enable widespread interoperability in healthcare.  Carequality is technology and vendor-neutral, inclusive, action-oriented, and offers immediate scalability.  Together with other members, we will drive industry consensus to develop and maintain a standards-based interoperability framework that enables information exchange.

Interoperability is a goal that requires the entire industry to make changes and work together.  We still have a long way to go, but through open dialogue with other industry leaders, and a commitment to making real progress, we are confident we can help guide this effort and positively impact the future of healthcare.

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