Table 2. Barriers to Interoperability Among APM and Non-APM Hospitals Among Hospitals Engaged in All 4 Domains of Interoperability in 2018.
| Characteristic | No. (%)a | P value | ||
|---|---|---|---|---|
| All hospitals | Non-APM hospitals | APM hospitals | ||
| APM hospitals more likely to report barrier | ||||
| Difficult to locate the address of the providerb to send the information (eg, lack of provider directory) | 697 (55.4) | 255 (44.1) | 442 (65.1) | <.001 |
| Providers we would like to electronically send patient health information to do not have an EHR or other electronic system with capability to receive the information | 605 (48.2) | 229 (39.6) | 376 (55.5) | <.001 |
| Difficult to match or identify the correct patient between systems | 491 (46.1) | 183 (37.0) | 308 (54.0) | <.001 |
| Many recipients of our electronic care summaries (eg, CCDA) report that the information is not useful | 487 (41.5) | 190 (32.9) | 297 (43.8) | <.001 |
| APM hospitals less likely to report barrier | ||||
| There are providers with which we share patients with that do not typically exchange patient data with us | 771 (72.5) | 393 (79.6) | 378 (66.3) | <.001 |
| We had to develop customized interfaces to electronically exchange health information | 342 (37.6) | 141 (43.5) | 201 (34.4) | .01 |
| APM and non-APM hospitals equally likely to report barrier | ||||
| Experience greater challenges exchanging (eg, sending/receiving data) across different vendor platforms | 735 (80.8) | 261 (80.7) | 474 (80.9) | .58 |
| Providers we would like to electronically send patient health information to have an EHR; however, they lack the technical capability to receive the information | 834 (66.4) | 390 (67.5) | 444 (65.5) | .99 |
| We have to pay additional costs to send/receive data with care settings/organizations outside our system | 376 (38.7) | 132 (40.8) | 244 (41.8) | .82 |
| Cumbersome workflow to send (not eFax) the information from our EHR system | 210 (16.7) | 95 (16.4) | 115 (17.0) | .62 |
| No technical capability to electronically receive from outside providers | 66 (6.2) | 31 (6.2) | 35 (6.1) | .94 |
| No technical capability to electronically send to outside providers | 32 (2.6) | 18 (3.2) | 14 (2.1) | .28 |
Abbreviations: AHA, American Hospital Association; APM, alternative payment model; CCDA, consolidated clinical document architecture; EHR, electronic health record.
a
Analysis of AHA Annual Survey and IT Supplement data, 2014 to 2018. Denominators can vary across questions, as nonrespondents were excluded and not all hospitals responded to every question.
b
The survey instrument uses the term provider, which can be ambiguous as to whether the respondents were indicating an individual clinician or practice; a care delivery organization, such as a hospital or clinic; or both. Future data collection efforts should make an effort to clarify this distinction.