What does the average American doctor think about available health information exchange technologies several years into the meaningful use program?
To answer that, the Office of the National Coordinator for Health IT and the Arizona Strategic Enterprise Technology office seperately conducted surveys of providers' HIE perspectives, and the research produced similar findings.
ONC, for its part, sponsored focus groups with 68 physicians at small, large and health system-based practices in Maine, Nebraska, Texas, Washington State and Wisconsin, in a study convened by the the University of Chicago’s National Opinion Research Center.
The doctors were interviewed in early 2012, all using electronic health records by then, and saw different benefits in HIE in part based on their size, specialist affiliations and patient needs.
Small practices were focused on using EHRs within their practices to improve efficiency and had limited use of information exchange. Large practice and health system-based physicians were more likely to be using HIE already and were interested in data analytics, exchange between unaffiliated practices, patient tracking, identification of drug-seeking patients and performance data for accountable care organizations.
Small practices were mostly looking to HIEs for referrals and consults with specialists and clinical care summaries with local hospitals — as some “note[d] their distrust of the completeness and quality of electronic records other providers send” and others expressed concerns about the timeliness of information in the state immunization registry.
At the time of the survey, almost two-thirds of large practice physicians and half of small practice physicians were exchanging health information, although only a few physicians in hospital-affiliated practices were aware of meaningful use stage 2 requirements for HIE activities.
Half of small practice physicians receive lab results directly into their EHRs and the rest use web portals to retrieve results, with some frustrated the lab results do not automatically flow into a patient’s chart. In some cases, “staff members print results from the lab portal and then scan them into EHRs,” which can render them incompatible with other records. All of the larger practice physicians were using unidirectional exchange, with lab results flowing directly into their EHRs, and a few had bi-directional HIE capabilities.
Many small practice physicians said setting up interfaces with labs was a challenge because of cost, scarce IT resources and lack of patient volume. Physicians working with multiple labs also said they did not enjoy facing dual workflows, taking paper, fax and electronic data from different labs.
“When you have that interface directly from a lab right to your EHR, you value that relationship,” a physician from a small practice in Washington said. “I am not really hot on my patients using outside labs because I’ll eventually get the data but it will be in a paper format that gets scanned; then I have to look in at a different area of the EMR to incorporate that data. Whereas, if it comes over the interface, I can put all the values side-by-side and look for trends.”
Most of the physicians were unaware of state-based HIE programs and regional extension centers; two physicians in Nebraska were using state-led services and two small practice physicians in Maine said they knew of HealthInfoNet. None of the physicians were aware of the Direct Project, and only a few were familiar with secure email.
Small practice physicians tended to be more involved in the EHR selection and implementation process, while larger practices had “one or two clinical champions or health IT specialists” in charge of the selection. About two-thirds of the physicians interviewed collected federal incentive payments and the rest were planning on it, although some said they thought the payments (about $44,000) were not enough to offset implementation and maintenance costs.
The Arizona Strategic Enterprise Technology office, meanwhile, released the results of an HIE community scan in Arizona, also surveying provider information exchange needs.
Respondents cited high costs and a lack of broadband availability as the two main challenges. At the same time, many providers said they were interested in HIE services for better coordination and mandated data reporting, in addition to EHR upgrades and interface development.