The US Government Accountability Office (“GAO”) recently surveyed providers about challenges they have faced while using Electronic Health Records (“EHR”) Systems. While the government encourages EHR use through EHR meaningful use incentive payments, providers reported issues with insufficient standards, concerns about how privacy rules can vary between states, difficulties in matching patients to their records, and costs associated with the exchange of electronic health information.

According to the report, some of this confusion is the fault of regulators, who have not yet standardized data to allow providers utilizing different electronic health records systems to pass data back and forth. For example, providers complained of a lack of standards for reporting allergic reactions. Because there are not sufficient standards to define these conditions, some EHR systems classify an allergic reaction as a side effect, while other EHR systems classify the same reaction as an allergy.

Similarly, the surveyed providers complained that there has been little, if any, effort to standardize healthcare information privacy rules across state lines. While the federal government directs providers to reference local rules, providers want to see a federal effort to make these rules more uniform. Providers find it difficult to exchange health information with providers in other states because of concerns about compliance with these rules. For providers located close to state borders, and therefore service patients from multiple states, this burden can be even higher.

The final major concern of providers surveyed by GAO is that it is difficult to match patients to their health records. Providers cited many examples where a single patient was entered into a system multiple times – making medical record consistency a challenge. Some called for a national patient identifier for matching patients to their records, but a 1999 Act prohibits HHS from using any funds to create a standard and system for providing individuals a unique health identifier until legislation is enacted specifically approving the standard.

To compile the report, GAO examined the key challenges to the electronic health exchange of information that have been reported by providers, and considers HHS’s efforts to address the same. Overall, GAO recognizes that not enough has been done.

GAO concludes the report by recommending that CMS and Office of the National Coordinator for Health Information Technology (ONC):

  1. develop and prioritize specific actions that HHS will take consistent with the principles of HHS’s strategy to advance health information exchange
  2. develop milestones with time frames for the actions to better gauge progress toward advancing exchange, with appropriate adjustments over time.

HHS, including CMS and ONC, concurred with these recommendations.

The full report can be accessed here.

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