June/July 2019

HIT Happenings: Demand for Data Sharing Mounts
By Julie Demaree, PA
For The Record
Vol. 31 No. 6 P. 8

A few months ago, the results of a public opinion poll conducted by Hixny and the Siena College Research Institute hit my desk. Hixny is a nonprofit community health information exchange (HIE) that I use on a daily basis, as do most of my colleagues in the eastern part of New York state, north of New York City. I find it to be a very useful tool—in my roles as both a patient and a provider—because it allows me to quickly find medical information from multiple facilities and practices.

When I read that Hixny had worked with Siena to poll 1,000 adult residents of the region about their perspectives on EHRs and the sharing of health data, I was curious to learn what they’d found. Though there has been much speculation, this is the first large survey I am aware of that’s gained real insight into what consumers are thinking.

Consumers Say: Share the Records
The poll shows that between 79% and 86% of consumers, including those in eastern New York, already expect their providers, insurers, and urgent care or emergency facilities to share their health records.

Beyond that, they strongly support the use of electronic tools to make that process easier. For example, consider the following:

• 94% believe that all of their health records should be accessible to their providers from one place;

• 92% believe Hixny would be useful to their doctors in providing treatment;

• 83% expect their providers to use Hixny; and

• 79% expect to use Hixny’s patient view themselves.

For the most part, consumers are comfortable with EHRs and computers in a health care setting. I see this in my own organization. Patients have been along for the ride as we’ve transitioned from paper charts to EHRs. They’ve seen us learn how to use new systems—and they’ve learned how to navigate portals and kiosks, too. Now, they want to see the benefit of these changes through the routine exchange of all those data we collect.

People are familiar with the security protocols in online banking and shopping. And they trust their health care providers. That’s a large reason why 93% of patients whose providers ask them for consent to use Hixny to exchange their health data electronically (as required by New York’s opt-in model) opt to do just that.

Nevertheless, 80% of consumers say they are repeatedly asked the same questions about their health histories and medications (57% of whom find that bothersome). I can hear that frustration from my patients when they visit a facility that is not connected to Hixny. They return to our office for follow-up, but their results don’t travel with them.

When practices share data with Hixny, other treating providers can immediately access updated treatment plans and results without phone calls or faxing; this eliminates frustrated patients. Clearly, we can work better as a team.

Providers Say: Improve the System
I understand where my patients are coming from because I am someone’s patient, too. I can’t always remember where and when I had a specific lab test or what year I had a specific procedure. Beyond that, because I know that Hixny’s HIE can make all of that information available with a simple log-in, I don’t have to keep all of those details in my head.

On the flip side, as a provider myself, I have experienced the learning curve and the workflow modifications that come with both EHRs and the introduction of external data from the HIE.

The biggest challenge is that the data that can be accessed through the HIE are only as good as the data our colleagues share through the HIE. If one facility delays entry of their patient data, then the HIE’s ability to make data available to every connected provider in real time is negatively affected.

Similarly, if providers are selective about what fields to complete, or facilities limit access to the HIE to only a certain echelon of their clinical staff, there is a good chance the data shared will be inconsistent. More importantly, those practices will not realize the time and money savings—and safety improvements—that consistent HIE use brings to organizations.

Some providers cite the difference between their EHR systems and the varied capabilities of their HIE connections as a significant barrier to more effective use of the HIE. The problem may stem from the manner in which EHR vendors and, by extension, HIEs attempted to fulfill general government guidelines in a competitive instead of a collaborative environment.

The resulting gaps in capabilities and data formats may be good for business, but they are ill-suited for patients. When the first rule of medicine is “do no harm,” my colleagues and I need to be certain that we have the best and most complete information available to help us care for our patients. That, and not the bottom line of any technology company, must be the priority.

Working Together
About 75% of the consumers polled by Hixny and Siena say they rely on their doctor’s office for information about health care as a whole, not just their own health conditions. That’s more than any other source, including websites and family and friends.

Everyone caring for a patient must serve as a role model and guide for the use of data and the exchange of information. My organization shares office notes through Hixny so that colleagues can see our patients’ most up-to-date treatment plans immediately. We share EKGs so that another provider treating a patient with chest pain has something to compare with. We review patient records before appointments to learn of previous care plans and histories. We also consult the HIE when we see new patients to review their previous testing before recommending our own.

All of this saves time by avoiding calls to several different organizations and the subsequent wait for records to arrive. It reduces costs by avoiding the needless repetition of tests. It also lets us compare new results with older ones—which is especially important for chronic disease management.

At the same time, we cannot ignore that the health care industry, led by managed care organizations, has been educating and engaging consumers in their own care for more than a decade. With the introduction of patient portals and apps that allow patients to monitor their own results and conditions, more and more people are taking those messages to heart. I encourage my patients to use Hixny’s patient view to see the most complete presentation of their records in the same way that I do.

Beyond anything else, the Hixny and Siena survey results illustrate that consumers are now way out in front of most of the health care industry in their level of acceptance and demand for electronic records sharing. For providers and everyone working in HIT, that should tell us that we need to learn to collaborate.

Putting Data in the Right Hands
Years ago, the federal government incentivized providers to implement EHRs and required them to begin measuring and reporting quality electronically.

Those efforts may create a certain level of efficiency, but they won’t improve the quality of health care or the patient experience until patients have access to the same information as the providers do—information that belongs to them, not to physicians, EHR vendors, HIEs, or state and federal governments.

Ultimately, the effective practice of medicine depends on trust. Consumers have a more positive health care experience when they know providers are working together to provide them with the best care possible. The fastest and most effective way to establish trust is to provide transparent, comprehensive, and easily accessible health information to each and every consumer.

— Julie Demaree, PA, is a physician assistant and clinical informatics specialist affiliated with Saratoga Hospital Medical Group in Saratoga Springs, New York.