Interoperability in cities is improving, but small hospitals lag behind

By | October 29, 2020

The U.S. Office of the National Coordinator for Health IT released a report this week examining the state of interoperability among hospitals within 15 major cities.

The brief, written by ONC Senior Health Economist Yuriy Pylypchuk and Public Health Analyst Christian Johnson, found that major U.S. cities have high rates of data interoperability, but variation exists.

“While cities are central to many cultural, economic, and transportation activities, these densely populated and interconnected centers can become vulnerable to infectious disease outbreaks and other health crises,” wrote Pylypchuk and Johnson. “Interoperable health information technology can play an important role in responding to these events.”  


Pylypchuk and Johnson examined hospitals’ ability to find, send, receive and integrate electronic health information with sources outside their health system.  

Of the 15 cities examined, Cleveland had the highest rate of hospitals that reported interoperable data sharing across these domains, followed by Miami, Detroit and Seattle.  

Philadelphia was the only city with an interoperability rate below the national average. Less than half of hospitals there, in Los Angeles, St. Louis and Washington, D.C., reported interoperable data sharing.  

Hospitals in eight cities showed major improvements since 2015, with Chicago leading: The proportion of facilities engaging in interoperability improved in the Windy City by about 140%. Improvement rates in New York and Boston weren’t far behind. Perhaps unsurprisingly, cities with a larger proportion of interoperable hospitals reported higher rates of providers with point-of-care information available.

Only 44% of small hospitals engage in interoperability, according to the brief, compared to 58% of medium or large ones. Similarly, independent hospitals are less likely to engage in interoperability than system-owned ones. Only 13% of small, independent hospitals reported finding, sending, receiving and integrating data.  

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The report also examined hospitals’ participation in state, regional or local health information exchanges. Nearly all hospitals in Detroit, Cleveland, Washington, D.C., and Seattle did so. By contrast, less than half of hospitals in Chicago and Atlanta reported participating in an HIE.

HIE participation and having an electronic health record from the developer with the largest local market share can improve interoperability rates, Pylypchuk and Johnson reported.

“Seamless and timely exchange of electronic health information can improve health outcomes and lower health care cost,” they said. “In particular, interoperable exchange has been found to reduce unplanned readmissions and duplicate testing. In the case of infectious disease outbreaks and other health crises, interoperability is an essential tool for treating patients and coordinating care across providers.

“Inability to effectively exchange electronic health information can have significant implications on patient outcomes and public health,” they added.  


Shortly after the report’s publication, ONC announced that it was extending the deadline for the information blocking rules and IT certification requirements outlined in the 21st Century Cures Act.  

“This is a careful balancing of the absolute importance of interoperability and standardized application programming interfaces with free and clear access to the information with the reality that we’ve heard from our provider-side stakeholders that they’re working so hard on some of the critical technical underpinnings of telehealth and other related resources that that have to be their first priority,” explained Dr. Don Rucker, national coordinator for health IT, on a Thursday press call.   

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ONC has also incentivized innovation in the realm of interoperability, awarding millions of dollars to projects focused on making information sharing seamless.  


“The 21st Century Cures Act  sought to improve the flow and exchange of electronic health information by prohibiting information blocking, enhancing the usability and accessibility of health IT, and creating a Trusted Exchange Framework and Common Agreement (TEFCA) to improve data sharing between HIEs,” Pylypchuk and Johnson wrote.

“The Office of the National Coordinator for Health IT recently finalized rulemaking to adopt many of these provisions in the Cures Act,” they said. “Together, these activities have the potential to improve access and exchange of electronic health information, and to give providers the necessary information to treat patients in a timely manner.”

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

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