By Elizabeth McElhiney, MHA, CHPS, CPHIMS, CRIS Director of Compliance and Government Affairs
Verisma
May 17, 2024

I recently had the honor to moderate a panel with really engaging, super bright, and deeply invested panelists who are looking at patient access from three perspectives:

• Health Information Management (HIM)
• Patient
• Patient Advocate

Key Challenges

We discussed how many places HIM professionals need to go to assemble a patient’s complete medical record within one organization. Chances are high that it’s not one electronic medical record (EMR). Often, hospital records and outpatient clinical records are in multiple systems. There’s also paper, microfiche, independent labs, imaging, and coordination with different providers and pharmacies to tackle. From a patient and patient advocate perspective, navigating the U.S. healthcare system to access protected health information (PHI) is also far from easy. In some states, consumers need more than one consent to release information. There are numerous usernames and passwords to remember when trying to access portals. These pose challenges even before acknowledging language and literacy barriers. Anna McCollister, member of the Sequoia Project’s Board of Directors and advisory committee member for the Health IT Advisory Committee (HITAC) at the Office of the National Coordinator for Health Information Technology (ONC), perfectly illustrates the complexity of living with complex, chronic disease. She’s asking health technology companies to think beyond what they’re in charge of. For consumers to feel less of a burden, health tech needs to understand their focus area is part of a much larger picture. Anna’s requesting a seamless platform, so consumers can see all their data in one place – saving valuable time and effort. This tool is even more important for patients who aren’t feeling 100 percent, and don’t have excess energy to give.

Managing PHI

Vong Miphouvieng, Vice President of HIM and Clinical Documentation Integrity at a large health system in Texas, agrees EMRs have made it somewhat easier to access data, but not everyone wants to use a patient portal. They partnered with Verisma to simplify access, creating a consumer-focused health system. With interoperability, patient information can now be obtained from one location. No matter where consumers receive care, there’s one phone number, one website, one email, one place they get all their health information. The provider also extended call-center hours, making it easier to access information in myriad ways via portal, snail mail, or walk-in – providing various methods to fit consumer needs.

Veronica Richardson, Vice President of Integrity at Preferred Family Healthcare (PFH), details challenges their transient clients have with mobility. Some don’t have smartphones to request information, and staff can’t always contact them either. They’ve also centralized the release of information (ROI) process so there’s one Dropbox. No matter where patients receive care, they can request records from PFH.

Government’s Role

Data rights need to be more visible when consumers are trying to access information in their provider’s office or in a patient portal. Required alerts describing patient rights, what’s available to be accessed in a portal, and who to contact if consumers can’t access data in a timely manner, need to be front-and-center – along with government contact information to report violations.

Bottom Line

We’ve been talking about interoperability for years, but there’s more work to be done to achieve seamless information sharing between healthcare providers and from one EMR to the next. The process to download, print, mail, and PDF data for integration into the receiving provider’s EMR is still daunting. Consumers are rightfully demanding faster turnaround times, and interoperability is the key for better patient access. The good news? We all know what’s needed. Together, we can define the remaining barriers, outline what’s keeping us from knocking them down, and define how we can work with the healthcare ecosystem and policy makers to get us to true interoperability.

Verisma

April 18, 2024

By January 2026, all certified electronic health record (EHR) users must comply and exchange information per the Trusted Exchange Framework Common Agreement (TEFCA). My colleague, Roberta Baranda, past president of the California Health Information Association (CHIA) and health information management (HIM) director at Valley Children’s Hospital spoke about TEFCA several years ago. I looked it up and thought, another government regulation to enforce what we’ve all been needing, wanting and working towards for many years, interoperability. If all of us are on the same page about interoperability, why is it so difficult to achieve?

An unprecedented amount of data is being collected across a diversity of sectors, which, if harnessed, could transform public health decision-making. Yet significant challenges stand in the way of such a vision, including the need to establish standards of data sharing and interoperability, the need for innovation in both methodological approaches and workforce models, and the need for data stewardship and governance models to ensure the protection and integrity of the public health data system. (Martin, et. al., 2022)

Why’s the Government Weighing in on Interoperability? Better Patient Outcomes

All healthcare professionals agree there’s a need for a viable, reliable method, and framework for health information to be exchanged. Most everything we do in health information ultimately results in trusted info being exchanged. When we analyze charts, the purpose is to ensure completeness of the record so the recipient will have the patient’s full story. When we code a record, the data are captured for research recipients and the payers to receive information pertaining to cost of care. Document imaging specialists ensure paper records are incorporated into the electronic version of the chart to provide continuity of care. Of course, clinicians feverishly document care of the patient knowing information will result in better outcomes or prevention of further illness.

Federal efforts may address some impediments to electronic health information exchange. Specifically, the Trusted Exchange Framework and Common Agreement being implemented by the Office of the National Coordinator for Health Information Technology (ONC)—which aims to describe a common set of nonbinding principles to help facilitate exchange among health information networks—may mitigate costs providers face by providing a simpler approach to connecting with other providers. However, stakeholders noted that participation in this effort is voluntary and does not address issues like information technology staffing shortages and gaps in broadband access that pose particular challenges to electronic exchange for small and rural providers. (Gordon, 2023)

Health Information Access Challenges

The government mandate speaks to the importance of access to health information. The vision of our national organization, American Health Information Management Association (AHIMA) is “A world where trusted information transforms health and healthcare by connecting people, systems, and ideas.” Can TEFCA be the conduit for us to get there? The National Institutes of Health (NIH) addresses implications and solutions for interoperability challenges, including a copious amount of health data with outdated workforce models, and numerous resource constraints.

Data science and technology companies continue to be on the cutting edge of information exchange. As such, the data science and technology sector has the expertise to help mitigate and solve challenges within legacy data systems… departments working within a resource-constrained environment and a workforce whose expertise is focused on health, rather than technology. In addition, to increase accuracy and efficiency, there is a need to develop processes for timely data sharing that require minimal human effort. (Martin et. al, 2022)

TEFCA Guidance Resources: ONC and AHIMA

During the February Verisma Academy webinar, Elisabeth Myers, Deputy Director, Office of Policy, ONC, presented an on-demand course with solid, actionable information that’s really worth checking out: Exploring HTI-1, TEFCA and AI in Healthcare – Where Are We in 2024?

Separately, AHIMA provided a two-page guideline on what TEFCA means for provider organizations, underlining the idea that when orgs exchange information through Qualified Health Information Networks (QHINs), “there’s increased focus on how to expand use cases and make a broader impact.” In terms of adaptability, “TEFCA will be able to grow and adapt as needed to ensure it serves user needs,” including “a three-year roadmap for the TEFCA to begin utilizing the Fast Healthcare Interoperability Resource (FHIR).”

Will TEFCA Help Solve Interoperability Challenges?

At the very least, TEFCA has us discussing this important topic and moving in a unified direction as an industry. Providers who struggle with resources to stay on top of what these regulations mean, or how to operationalize them, can lean on external partners who’ve expertise in this space – ultimately benefiting everyone.

I’m proud to work for a company fostering interoperability with technology-rich tools mitigating human error. We help provider partners manage the deluge of incoming records, care coordination processes, and sharing information — with privacy and security at the forefront. We’re also passionate about becoming your trusted partner.

References:

www.ahima.org; What Does the TEFCA Mean for Your Organization?
https://ahima.org/media/zw3hx0c3/tefca_summary_fin.pdf

Martin LT, Nelson C, Yeung D, Acosta JD, Qureshi N, Blagg T, Chandra A (2022) The issues of interoperability and data connectedness for public health. Big Data 10:S1, 19–24, DOI: 10.1089/big.2022.0207.

Gordon, L. (2023) Electronic Health Information Exchange: Use Has Increased, but Is Lower for Small and Rural Providers. GAO-23-105540; Published: Apr 21, 2023.
https://www.gao.gov/products/gao-23-105540.