Healthcare providers in the United States are facing more challenges in improving how patient health records are shared and accessed. Interoperability means different health information systems can work together and exchange data easily. This is important for providing timely and coordinated care. Even with new technology, many healthcare groups still find it hard to share patient information quickly. These problems often cause delays, more work for staff, repeated tests, and unhappy patients.
This article looks at current problems with health data sharing, new rules, and practical steps for medical managers, healthcare owners, and IT leaders to improve data transfer and access to patient records. It also talks about how artificial intelligence (AI) and automation are helping. Knowing this can help healthcare groups handle the challenges of health information exchange (HIE) while keeping data safe and following rules.
Healthcare has spent billions on electronic health records (EHRs), but it is still hard to share data smoothly between providers and patients. Common problems include systems that don’t connect well, different data formats, and staff not trained enough. Many records are still on paper, or sent by fax or mail, which delays important clinical information.
For example, a patient may need records from several specialists who use different systems that do not talk to each other. One provider might send paper copies, while another requires visiting in person to get records. Patients often get frustrated with these delays. One mother said she had to drive 90 minutes to pick up records from one specialist, while others were mailed or only available through complex online forms. These issues cause delays and make it harder for patients to stay involved in their care.
Incomplete or wrong records are also a big problem. One patient saw no shots listed on the portal even though her doctor had recorded them. This can cause repeated tests, medicine errors, and broken care plans.
To sum up, healthcare groups face these main problems with interoperability and data transfer:
Health Information Exchange (HIE) is a technical way to help interoperability. HIE lets authorized healthcare providers and patients share health data electronically. This can make care faster, safer, and more efficient.
There are three main types of HIE:
The Office of the National Coordinator for Health Information Technology (ONC) supports these types of HIE to improve care and cut down mistakes. But many groups still face tech and organizational barriers. Lack of standard rules and disconnected systems often block full adoption.
Electronic Health Records (EHRs) replace paper charts in many places. They store patient data like history, medicines, lab results, vaccines, and images in real time. Unlike Electronic Medical Records (EMRs) that stay in one place, EHRs are made to share data across healthcare groups.
EHRs use medical coding like ICD and SNOMED CT to keep information consistent and accurate. Many also include tools to help doctors decide and predict outcomes using AI and machine learning.
Still, EHRs have challenges:
These problems can delay data access and cause loss during care changes. Also, some staff don’t have enough HIPAA training, increasing risk of data mistakes.
New federal rules aim to make data sharing easier and cut down paperwork for providers, payers, and patients.
The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), issued in January 2024, sets standards for smooth health data exchange and simpler prior authorizations. This builds on earlier rules by requiring payers to use APIs based on the Fast Healthcare Interoperability Resources (FHIR®) standard.
By January 1, 2026, most payers must follow these rules, with some extensions until 2027. The rule promotes FHIR-based APIs to allow real-time electronic exchange of patient records and prior authorizations among providers and payers. This improves transparency and speeds up processes.
The National Standards Group (NSG) agreed to not enforce older standards for entities that choose the FHIR API approach. This helps new tech adoption and easier changes. Along with these rules, CMS gives best practice guides and learning tools for patients and providers.
This policy shift supports a more connected healthcare system with less paperwork and faster patient record access.
Healthcare leaders managing practice and IT can use these steps to improve data transfer and access:
Choose or upgrade to EHR systems that are built for interoperability and support FHIR standards. These systems can securely share patient data with other providers and payers, cutting down on paper and fax methods.
Cloud-based EHRs provide options for growth and stronger security, helping compliance with HIPAA and other laws. Leaders should look for systems with good analytics and decision support to better manage patients.
Create clear, consistent workflows for handling records requests, authorizations, and data sharing. Train staff well on privacy rules and best steps to reduce mistakes and keep fast processing.
Setting up a central records team can make managing requests smoother and avoid mixed handling. Giving patients easy online portals to ask for and track records cuts down on staff workload and improves patient experience.
Use consumer-mediated exchanges to let patients manage their own health data. Teach patients about their rights and available tools to build trust and avoid missing or wrong information affecting care.
Patient portals should show complete, current records, including vaccines and specialist notes. This reduces confusion caused by missing data. Clear communication about request status and timing helps lessen patient worries.
Work with other providers, payers, and HIE groups to keep data flowing smoothly. Joining regional or national HIE networks helps share patient info widely, which is key for unexpected or emergency care.
Make sure all partners use compatible standards like FHIR to support smooth data exchange beyond one practice or system.
Keep up with changing rules on data access and prior authorization like those from CMS. Update tech and policies to stay compliant, avoid penalties, and keep operations running well.
Regular staff training on HIPAA and interoperability supports safe and legal data use.
AI and automation are becoming more important for better data sharing and managing patient records. They can cut down manual work, improve accuracy, and speed up processes.
For instance, AI can automate front-office phone calls and answering services, easing staff workload. Some companies like Simbo AI offer such solutions. Automating routine calls about record requests or appointments helps patient satisfaction.
In EHRs, AI analytics can find gaps or errors in patient data, like missing vaccines or possible medicine conflicts before they cause harm. Machine learning can predict risks and help manage care, such as spotting patients likely to be readmitted to the hospital.
Automation also speeds up prior authorizations by working with FHIR-based APIs. This reduces wait times and lessens staff tasks. Electronic processing lowers errors from filling forms by hand.
To use AI and automation well, practices should:
As healthcare gets more connected and tech-driven, AI and automation will be important for smooth, patient-focused interoperability.
Patient stories show the problems caused by poor interoperability. Delays in getting records, different data at each provider, and unclear communication disrupt care and add stress. People recovering from injuries or with long-term illnesses often feel the strain when they have to gather records from many specialists.
Healthcare groups that understand these problems can work on making data sharing clear and easy to access digitally. Letting patients securely request, view, and share records online with quick updates reduces frustration and helps care coordination.
For example, including all vaccine data and specialist notes in portals stops confusion and repeated tests. Making it easier so patients don’t have to visit offices or send many forms saves time and boosts convenience.
Providing simple, clear explanations about rights to access records builds patient trust. Better interoperability helps patients, providers, and staff by making information flow smoother and more reliable. This is key for good healthcare.
Improving how patient health records are shared and accessed needs healthcare groups to use interoperable technology, simplify workflows, and follow new regulations. AI and automation can also make processes faster and more accurate while reducing extra work.
Medical practice managers, owners, and IT leaders have a big role in guiding their teams through this change. By focusing on interoperable EHRs, training staff, giving patients the right tools, and working with health information networks, providers can coordinate care better, avoid repeated tests, and improve patient outcomes in the United States.
The changing rules, like CMS’s 2024 Interoperability and Prior Authorization Rule, push healthcare to be more open and accessible. Adjusting to these rules helps practices stay legal and competitive in an increasingly digital healthcare world.
Patients often encounter incomplete or inaccurate information in patient portals, difficulties sharing or transferring data, and a lack of transparency regarding their rights and options in accessing records.
The goal is to ensure patients have easier access to their health data, allowing for better coordination of care, prevention of unnecessary tests, and greater control over their well-being.
Human-centered design (HCD) methods were employed, involving consumer interviews and analysis of medical record release forms from various health systems.
The process typically involves an initial inquiry, filling out a records request authorization form, waiting for processing, and finally receiving the records.
The fulfillment often results in antiquated formats like printed records or CDs, requiring manual entry into EHR systems by the receiving provider.
Both groups desire complete, accurate records, online accessibility to records, fast and portable data transfer, and transparency in the request process.
Patient portals can streamline access to records, but not all portals provide comprehensive information, leading to frustration for patients.
Key personas include caregivers and patients facing delays, conflicting information, and limited digital literacy, leading to stress and confusion during the records request process.
Contributing factors include lack of standardized processes, incomplete information in records, and inadequate staff training on HIPAA regulations.
Recommendations include developing interoperable systems for data transfer, improving online record management, ensuring clear communication, and training healthcare staff on processes and regulations.
Simbo is using AI agents to automate all phone related workflows. Connect now to know more.
Schedule AI Agents Demo Now© Since 2019, Simbo AI.
