{"id":165305,"date":"2023-01-24T18:40:37","date_gmt":"2023-01-24T18:40:37","guid":{"rendered":"https:\/\/beta.healthit.gov\/dashboard_library\/interoperability-and-methods-exchange-among-hospitals-2021\/"},"modified":"2026-01-21T22:40:19","modified_gmt":"2026-01-22T03:40:19","slug":"interoperability-and-methods-exchange-among-hospitals-2021","status":"publish","type":"data-brief","link":"https:\/\/healthit.gov\/data\/data-briefs\/interoperability-and-methods-exchange-among-hospitals-2021\/","title":{"rendered":"Interoperability and Methods of Exchange among Hospitals in 2021"},"content":{"rendered":"\n
Interoperable exchange of health information or \u201cinteroperability\u201d is critical for delivering appropriate care, reducing health care costs, and making health care more efficient (1-3). ONC is executing on a number of health IT provisions from the 21st Century Cures Act, such as the Trusted Exchange Framework and Common Agreement (TEFCA) and Information Blocking provision that seek to advance interoperability (4-5). As these provisions are implemented, it is important to monitor interoperable information exchange to evaluate present policies and undertake future actions to advance interoperability. This data brief presents the state of interoperability among hospitals, as of 2021. We present trends on information exchange and the availability and use of information at the point of care, while also highlighting key barriers to interoperability. Additionally, we highlight the methods hospitals used to exchange health information and their participation in national networks and health information exchanges (HIEs).<\/p>\n\n\n\n
Highlights<\/h2>\n\n\n\n
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In 2021, more than 6 in 10 hospitals engaged in key aspects of electronically sharing health information (send, receive, query) and integrating of summary of care records into EHRs, a 51 percent increase since 2017.<\/li>\n\n\n\n
Availability and usage of electronic health information received from outside sources at the point of care significantly increased over the last four years, reaching 62 and 71 percent, respectively, in 2021.<\/li>\n\n\n\n
Health Information Service Providers (HISPs) and HIEs were the most common methods used for electronic exchange among hospitals.<\/li>\n\n\n\n
About three-quarters of hospitals participate in health information exchange organizations (HIEs) and about 35 percent participate in both HIEs and national networks.<\/li>\n\n\n\n
In 2021, 39 percent of hospitals reported participating in more than one of four measured national networks.<\/li>\n\n\n\n
Nearly 90 percent of hospitals upgraded their EHRs to 2015 Edition through 2021 and 74 percent of hospitals adopted bulk data export technology.<\/li>\n<\/ul>\n\n\n\n
Hospitals\u2019 engagement in three domains of interoperability (receive, find, and integrate) significantly increased since 2017.<\/h2>\n\n\n\n
Findings<\/h3>\n\n\n\n
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About 80 percent of hospitals electronically queried or found any patient health information in 2021.<\/li>\n\n\n\n
Since 2017, rates of integrating summary of care records demonstrated the largest improvements (21 percentage points) followed by finding information (19 percentage points).<\/li>\n\n\n\n
The percent of hospitals that engaged in all aspects of exchange (send, receive, query) and integrating of summary of care records into EHRs increased by 51 percent from 2017-2021.<\/li>\n<\/ul>\n\n\n\n
Figure 1: <\/strong>Percent of U.S. non-federal acute care hospitals engaging in electronically sending, receiving and integrating summary of care records and searching\/querying any health information 2017-2021.<\/p>\n\n\n\n
Source: AHA Annual Survey Information Technology Supplement. Notes: See Definitions for detailed definitions of interoperability domains. Study population are non-federal acute care hospitals. See Data Sources and Methods for more information. *Significantly different from 2017 (p<0.05).<\/figcaption><\/figure>\n\n\n\n
Small and rural hospitals made significant gains in having information electronically available at the point of care, reaching 50 percent in 2021.<\/h2>\n\n\n\n
Findings<\/h3>\n\n\n\n
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Overall, the percent of hospitals with information available at the point of care increased by 22% between 2017 and 2021, while rural and small hospitals’ rates of having information available increased by over 25%.<\/li>\n\n\n\n
Usage of information received electronically from outside sources increased at twice the rate for rural and small hospitals versus their counterparts (40% vs. 20%) between 2017 and 2021.<\/li>\n\n\n\n
Rural and small hospitals lagged their counterparts in engagement in four domains of interoperability in 2017 and 2021.<\/li>\n<\/ul>\n\n\n\n
Table 1: <\/strong>Percent of hospitals having availability and use of patient health information electronically received from outside sources by hospital type, 2017 vs. 2021.<\/p>\n\n\n\n
Hospital Type<\/th>
2017 (%)<\/th>
2021 (%)<\/th><\/tr><\/thead>
Electronic Health Information Available from Outside Sources<\/th><\/tr>
All Hospitals<\/th>
51<\/td>
62*<\/td><\/tr>
Suburban\/Urban<\/th>
61<\/td>
71*<\/td><\/tr>
Rural<\/th>
38<\/td>
48*<\/td><\/tr>
Medium\/Large<\/th>
61<\/td>
72*<\/td><\/tr>
Small (under 100 beds)<\/th>
41<\/td>
52*<\/td><\/tr>
Use of Electronic Health Information Received from Outside Sources<\/th><\/tr>
All Hospitals<\/th>
55<\/td>
71*<\/td><\/tr>
Suburban\/Urban<\/th>
64<\/td>
77*<\/td><\/tr>
Rural<\/th>
42<\/td>
61*<\/td><\/tr>
Medium\/Large<\/th>
64<\/td>
78*<\/td><\/tr>
Small (under 100 beds)<\/th>
46<\/td>
65*<\/td><\/tr>
Engagement in all Four Domains of Interoperability (see Figure 1)<\/th><\/tr>
All Hospitals<\/th>
41<\/td>
62*<\/td><\/tr>
Suburban\/Urban<\/th>
51<\/td>
72*<\/td><\/tr>
Rural<\/th>
27<\/td>
48*<\/td><\/tr>
Medium\/Large<\/th>
50<\/td>
74*<\/td><\/tr>
Small (under 100 beds)<\/th>
32<\/td>
51*<\/td><\/tr><\/tbody><\/table>Source: AHA Annual Survey Information Technology Supplement. Notes: *Significantly different from 2017 (p<0.05).\n\t<\/figcaption><\/figure>\n\n\n\n
As of 2021, almost nine out of ten hospitals had upgraded their EHRs to the most recent certified EHR technology (2015 Edition).<\/h2>\n\n\n\n
Findings<\/h3>\n\n\n\n
\n
Almost three-quarters of hospitals incorporated bulk data export technology into their EHRs as of 2021. The bulk data export technology enables a hospital to export patient data for all or some of its patients simultaneously.<\/li>\n\n\n\n
Among hospitals that adopted bulk data export technology, analytics and reporting was the most common use of bulk data export technology (84 percent) followed by population health management (47 percent).<\/li>\n\n\n\n
Among hospitals that adopted bulk data export technology, only 12 percent of hospitals had not used bulk data export technology.<\/li>\n<\/ul>\n\n\n\n
\n
\n
Figure 2. <\/strong>Percent of hospitals that upgraded EHRs to 2015 Edition and adopted bulk data export technology, 2021.<\/p>\n\n\n\n
Source: AHA Annual Survey Information Technology Supplement.<\/figcaption><\/figure>\n<\/div>\n\n\n\n
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Table 2.<\/strong> Percent of hospitals that applied data export technology for specific uses among those that adopted bulk data export technology, 2021.<\/p>\n\n\n\n
Uses of bulk data export capability<\/th>
%<\/th><\/tr><\/thead>
Analytics and reporting<\/th>
84<\/td><\/tr>
Population health management<\/th>
47<\/td><\/tr>
Switching EHR systems<\/th>
12<\/td><\/tr>
Have not used the capability yet<\/th>
12<\/td><\/tr><\/tbody><\/table>Source: AHA Annual Survey Information Technology Supplement. Note: Sample consists of hospitals that reported having bulk data export capability. Information Technology Supplement, 2021. Sample consists of hospitals that reported having bulk data export capability.<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n
The use of HISPs and HIEs remain the most common methods hospitals used for electronically sending and receiving summary of care records in 2021.<\/h2>\n\n\n\n
Findings<\/h3>\n\n\n\n
\n
About half of hospitals used interface connections that did not involve third-parties or networks to electronically send patient health information.<\/li>\n\n\n\n
Access to other organizations\u2019 EHR system using login credentials and interface connection between EHR systems were the least common methods used by hospitals for receiving summary of care records.<\/li>\n<\/ul>\n\n\n\n
Table 3: <\/strong>Percent of hospitals that often or sometimes send or receive summary of care records with sources outside their hospital system by method, 2021.<\/p>\n\n\n\n
Method<\/th>
Send (%)<\/th>
Receive (%)<\/th><\/tr><\/thead>
Electronic Method Not Using Third-Party or Network<\/th><\/tr>
Provider portal that enables viewing of another organizations\u2019 EHR system<\/th>
55%<\/td>
34%<\/td><\/tr>
Interface connection between EHR systems (e.g. HL7 interface)<\/th>
48%<\/td>
28%<\/td><\/tr>
Access to other organizations\u2019 EHR system using login credentials<\/th>
53%<\/td>
26%<\/td><\/tr>
Electronic Method Using a Third-Party or Network<\/th><\/tr>
HISPs that enable messaging via Direct protocol<\/th>
68%<\/td>
58%<\/td><\/tr>
State, regional, or local HIE<\/th>
65%<\/td>
56%<\/td><\/tr>
EHR vendor-based network that enables exchange between users of a single EHR vendor<\/th>
44%<\/td>
43%<\/td><\/tr>
National networks that enable exchange across different EHR vendors (e.g. Carequality)<\/th>
47%<\/td>
45%<\/td><\/tr>
Non-Electronic Method<\/th><\/tr>
Mail or fax<\/th>
69%<\/td>
78%<\/td><\/tr>
eFax using EHR<\/th>
67%<\/td>
62%<\/td><\/tr><\/tbody><\/table>Source: AHA Annual Survey Information Technology Supplement. Notes: National networks exclude EHR vendor-based networks.\n\t<\/figcaption><\/figure>\n\n\n\n
Over 60 percent of hospitals used an HIE to electronically query or find patient health information from external sources in 2021.<\/h2>\n\n\n\n
Findings<\/h3>\n\n\n\n
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Over 45 percent of hospitals used national networks, interface connections between EHRs, or EHR-vendor based networks to query patient health information from external sources.<\/li>\n\n\n\n
Access to other organizations\u2019 EHR systems using login credentials remained the least commonly used method for querying patient information.<\/li>\n<\/ul>\n\n\n\n
Figure 3:<\/strong> Methods used by hospitals to electronically find (or query) patients\u2019 health information, 2021.<\/p>\n\n\n\n
<\/figure>\n\n\n\n
The average number of methods hospitals used for electronically sending, receiving, and finding patient health information from external sources increased between 2018 and 2021.<\/h2>\n\n\n\n
Findings<\/h3>\n\n\n\n
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On average, in 2021 hospitals used about three methods (out of 7 possible methods) for receiving summary of care records.<\/li>\n\n\n\n
On average, in 2021 hospitals used more methods (3.8) for electronically sending summary of care records and fewer methods for electronically finding or querying (2.7) patient health information.<\/li>\n<\/ul>\n\n\n\n
Figure 4: <\/strong>Average number of electronic methods hospitals used to send, receive, and find (or query) health information, 2018 and 2021.<\/p>\n\n\n\n
Source: AHA Annual Survey Information Technology Supplement. Notes: *Significantly different from 2018 within a corresponding category (p<0.05).<\/figcaption><\/figure>\n\n\n\n
Hospital participation rates in state, regional, or local network remained high, at about 75 percent in 2021.<\/h2>\n\n\n\n
Findings<\/h3>\n\n\n\n
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The percent of hospitals participating in both national and state, regional, or local networks increased from 53% to 64% between 2018 to 2021.<\/li>\n\n\n\n
Less than 1 in 5 hospitals chose not to participate in either national network or state, regional, or local networks in 2021. There is no difference compared to 2018.<\/li>\n<\/ul>\n\n\n\n
Figure 5: <\/strong>Percent of hospitals that participate in national and state, regional, or local health information networks, 2018- 2021.<\/p>\n\n\n\n
Source: AHA Annual Survey Information Technology Supplement. Notes: National network consists of hospital participation in CommonWell Health Alliance, e-Health Exchange, Sequoia Project’s Carequality, Strategic Health Information Exchange Collaborative (SHIEC), as well as EHR vendor’s network. *Significantly different from 2018 within a corresponding category. (p<0.05).<\/figcaption><\/figure>\n\n\n\n
Hospital participation in CommonWell Health and Sequoia Project\u2019s Carequality significantly increased between 2018 and 2021.<\/h2>\n\n\n\n
Findings<\/h3>\n\n\n\n
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Hospital participation in Carequality increased by 14 percentage points, the largest increase among national networks.<\/li>\n\n\n\n
In addition to the four networks below, in 2021, 90% of hospitals participated in Direct messaging enabled by the Direct Protocol and the DirectTrust.<\/li>\n<\/ul>\n\n\n\n
Table 4: <\/strong>Hospital participation in query-based national networks, 2018-2021.<\/p>\n\n\n\n
National Network<\/th>
2018<\/th>
2021<\/th><\/tr><\/thead>
CommonWell Health Alliance<\/th>
19%<\/td>
29%*<\/td><\/tr>
e-Health Exchange<\/th>
25%<\/td>
29%<\/td><\/tr>
Sequoia Project’s Carequality<\/th>
20%<\/td>
34%*<\/td><\/tr>
EHR vendor’s network<\/th>
32%<\/td>
43%*<\/td><\/tr><\/tbody><\/table>Source: AHA Annual Survey Information Technology Supplement. Notes: *Significantly different from 2018 (p<0.001).\n\t<\/figcaption><\/figure>\n\n\n\n
In 2021, about 4 in 10 (39%) hospitals reported participating in more than one of four measured national networks.<\/h2>\n\n\n\n
Findings<\/h3>\n\n\n\n
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Eleven percent of hospitals reported only participating in CommonWell Health Alliance and no other national network.<\/li>\n\n\n\n
There were few hospitals (0.6%) that only participate in Carequality and no other national network, consistent with its role as a framework.<\/li>\n<\/ul>\n\n\n\n
Figure 6: <\/strong>Relationship between participation in each national network in 2021.<\/p>\n\n\n\n
Source: AHA Annual Survey Information Technology Supplement. Notes: Figure does not include 37% of hospitals that did not participate in a national network. See Appendix Figure for a simplified exposition of these relationships.<\/figcaption><\/figure>\n\n\n\n
Summary<\/h2>\n\n\n\n
Interoperability continues to improve among hospitals. As of 2021, 88% of hospital engaged in electronically sending and obtaining patient health information, through either querying or electronically receiving summary of care records. The number of hospitals engaged in integrating patient health information into EHRs grew by 40% since 2017, with about three-quarters of hospitals engaging in this activity in 2021. These trends show progress in interoperable exchange.<\/p>\n\n\n\n
Progress has been made in the rate at which hospitals report providers have electronic patient health information available at the point of care and use that information during 2017-2021. Rural and small hospitals\u2019 rates of having information available at the point of care increased by over 26% reaching 48% in 2021, and nationally it grew over 20%, reaching 62% in 2021. Additionally, usage of information received electronically from outside sources by rural and small hospitals increased at twice the rate of hospitals nationally (over 40% vs. over 20%) between 2017 and 2021. Yet, these less resourced hospitals are still not on par with their counterparts, indicating the need to continue addressing challenges with having full access to electronic information from external sources.<\/p>\n\n\n\n
Hospitals\u2019 rapid improvements in interoperability could be attributed in part to the initial implementation of health IT provisions from the ONC Cures Act Final Rule (Cures Rule) and adoption of 2015 Edition certified technology. The Cures Rule updated the Health IT Certification Program to include new and updated criteria and standards that will advance interoperability. Nearly 90% of hospitals have adopted 2015 Edition certified technology and are well positioned to adopt these new and updated criteria and standards. Other data show that a large majority of hospitals have already done so (6). Additionally, seventy-four percent of hospitals adopted the bulk data export capability, as of 2021. The most common uses of bulk data export were for analytics and reporting (63%) and population and health management (35%), and, less so, for switching EHRs (12%).<\/p>\n\n\n\n
Hospitals continued to use a variety of electronic exchange methods to achieve progress in interoperability. Compared to 2018, in 2021 hospitals were using more methods to send (3.8 out of 7), receive (2.9 out of 7) summary of care records, and find (2.7 out of 6) patient health information. The use of HISPs and HIEs were the most commonly used electronic methods for sending and receiving information. The use of HIEs and interface connections with EHRs were the most commonly used methods for finding patient health information. About 4 in 10 hospitals continued to participate in multiple networks, indicating possible challenges to exchange across different networks and thus reinforcing the need for having multiple networks. Policy activities that support cross-network exchange such as Trusted Exchange Framework and Common Agreement (TEFCA) will help reduce the number of different networks and methods that hospitals need to use to support exchange.<\/p>\n\n\n\n
Launched in early 2022, TEFCA aims to establish a universal policy and technical floor for nationwide interoperability and simplify connectivity for organizations to securely exchange information (7). Other provisions of the Cures Rule are being implemented now to help hospitals shift from simply establishing connectivity to optimizing and simplifying the use of multiple methods of exchanging information. However, some barriers to information exchange remain prevalent. For instance, 48% of hospitals reported one-sided sharing relationships in which they share patient data with other providers who do not in turn share patient data with the hospital (Appendix Table).<\/p>\n\n\n\n
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