Lack of interoperability among health information technology (HIT) systems in the U.S. is a major contributor to the fragmentation of health care itself, and impedes progress toward more coordinated, safer, more efficient care. In Moving the Needle on HIT Interoperability, the second in CAPP’s three-part series of white papers, Implementing Health System Improvement, CAPP members call on policymakers to accelerate the drive toward HIT interoperability.

The report lauds the passage of the 2009 HITECH Act, which has resulted in the vast majority of physicians and hospitals now using electronic health records (EHRs). But having access to EHRs is only a first step; the critical next step is ensuring that the information contained in EHRs paints a full clinical picture — and that requires interoperability among systems. Rather than focusing broadly on interoperability, however, providers responding to the incentives of the HITECH Act have had to focus narrowly on meeting specific functional targets and process measures within EHRs to ensure documentation of activities.

“We have the EHRs in place. Now it’s time to make sure they can talk to each other and that when they do, they have something meaningful to say,” says CAPP Chair Dr. Stephen Parodi, Executive Vice President of the Permanente Federation. “As a clinician, it’s not helpful to be told by my EHR that my patient missed a flu shot if, in fact, she actually received the shot at a clinic down the street, which isn’t part of our system. To be certain that the care we provide is as well-coordinated, efficient, and convenient for patients as possible, we need access to information about all the care they receive, not only from our own system, but from any other provider they might see in the community.”

To move more quickly toward HIT interoperability, regulators must take a stronger stand and provide more incentives to encourage it. Equally important, health care stakeholders must shift their thinking, recognizing that information about a patient belongs to that patient, not to any single provider or IT vendor. As the report notes, “This shift in thinking requires that full information follow patients — and be readily available to them — wherever they may receive care.”

The report concludes that policymakers must bringing stakeholders together to address specific issues that have stalled progress on HIT interoperability, including improved metrics of EHR functionality, reducing providers’ documentation burden, and implementation of unique patient identifiers.  In addition, as the Office of the National Coordinator for Health Information Technology moves forward with implementation of Meaningful Use Stage 3, the report recommends that “the agency should shift its focus from interoperability process measures… to outcomes measures, such as whether all necessary patient information is available at the point of care.”