Shared health information
Digital Health Evidence Review - This section provides information about how health information is shared between healthcare organisations.
What is interoperability?
Australia’s National Digital Health Strategy defines interoperability in its simplest form as the ability to move information easily between people, organisations and systems.  In addition, when information is shared between people and systems, its meaning must be kept so that from one context to another the information means the same thing. Interoperability supports people and health systems to experience connected care.
What level of information sharing occurs between healthcare organisations?
In the UK, the National Health Service (NHS) asks secondary care providers (e.g. hospitals, mental health, and acute care) to complete a Digital Maturity Self-Assessment survey. This survey measures the current level of digital services the healthcare organisations are using and provides an overview of how the country is doing as a whole.
In regards to information sharing between healthcare provider organisations the 2016 UK Digital Maturity Survey showed :
In the US, efforts have been made to survey different types of information sharing so that these can be consistently measured and tracked over time. The core components of interoperability or information sharing in this survey were:
Ability to query for patient data from outside institutions. Particularly important for unplanned, emergency care.
Providing patient information to outside organisations during planned care transitions (e.g. referrals, following hospital discharge).
Information is shared electronically with no special effort on the part of the user needed to merge information into a provider's EHR.
Getting patient information from outside organisations during planned care transitions (e.g. referrals, following hospital discharge)
In a 2014 survey of 3307 US hospitals, participants were asked, ‘Do providers at your hospital routinely have necessary health information available electronically from outside providers or sources when treating a patient who was seen by another healthcare provider/setting?‘. Key findings of the survey data showed :
- 21% of hospitals could perform all four functions related to sharing information (find, send, receive and integrate). 17% could do three functions, 20% could do two and 17% could do one function. A further 25% could do none of these functions.
- For those with only one function, the most common was to send (47.7%) then find (23%) information.
- The hospitals who could complete all four functions were more likely to be medium-sized, part of a system, and participating in medical home model participation.
- 36% of hospitals reported having health information available from outside providers when needed. These hospitals were more likely to be government owned rather than private and have answered yes to all four of the functions above.
The US has shown growth in sharing information between organisations. The percentage of hospitals that could electronically exchange summary care records with hospitals outside their system rose from 22% in 2011 to 57% in 2014. 
What is the experience of clinicians with information sharing?
In Finland, usability surveys were done throughout 2010 and 2014 to assess user experience of healthcare providers with EHRs. Clinicians were asked about the degree to which EHRs supported collaboration and information exchange between clinicians working in different organisations. Key findings were :
- In public hospitals, there was no change between 2010 and 2014 with 17% agreeing EHRs supported information exchange
- In public healthcare centres, there was a 4% increase from 15% in 2010 to 19% in 2014
- In private health, there was a 4% increase from 5% in 2010 to 9% 2014
- Overall, this was a significant 2% increase from 14% in 2010 to 16% in 2014
Figure 1 Percentage of clinicians in Finland who agreed that EHRs supported collaboration and information exchange, 2010 - 2014
System-wide information sharing requires access to EHRs across the full spectrum of care. One example of significant differences between clinical types and access to shared information is from cancer services within Canada. Key findings were :
- Overall, 22% of clinicians reported access to other organisation’s EHRs.
- Medical oncologists and ‘other’ physicians were more likely than surgeons to report access to other organisation’s EHRs.
- Those working in community-based care were six times less likely than those in teaching hospitals to report access to other organisation’s EHRs.
Interoperability is a fundamental requirement for any large-scale digital health implementation but international experience shows that true interoperability is a challenging goal. Within healthcare organisations, clinicians have varying experiences with information sharing. Fulfilling the capacity to share information electronically has important implications for supporting patients throughout the full continuum of care.
1 Australian Digital Health Agency. Australia's National Digital Health Strategy. 2017.
Available from: https://www.digitalhealth.gov.au/about-the-agency/publications/australias-national-digital-health-strategy [Accessed 11th Dec 2017].
2 National Health Service (NHS). Digital Maturity Assessment 2015/2016.
Available from: https://data.england.nhs.uk/dataset/digital-maturity-assessment-2015-2016. [Accessed 9th Dec 2017].
3 Holmgren AJ, Patel V, Charles D, Adler-Milstein J. US hospital engagement in core domains of interoperability. Am J Manag Care. 2016;22(12):e395-e402.
4 Association Hospital Association (AHA). Trendwatch: Hospitals Advance Information Sharing, but External Barriers to Increased Data Exchange Remain. 2016.
Available from: https://www.aha.org/guidesreports/2016-02-29-trendwatch-hospitals-advance-information-sharing-external-barriers [Accessed 12th Dec 2017].
5 Kaipio J, Lääveri T, Hyppönen H, Vainiomäki S, Reponen J, Kushniruk A, et al. Usability problems do not heal by themselves: National survey on physicians’ experiences with EHRs in Finland. International Journal of Medical Informatics. 2017;97(Supplement C):266-81.
6 Orchard MC, Dobrow MJ, Paszat L, Jiang H, Brown P. Access to electronic health records by care setting and provider type: perceptions of cancer care providers in Ontario, Canada. BMC Med Inform Decis Mak. 2009;9:38.