Physicians cite ongoing barriers limiting EHR access to outside patient information

A new national survey of 8,122 family physicians found that only 8% to 19% reported what the researchers described as “ideal interoperability” when accessing outside data and documents in their EHR. These findings, published in JAMA Network Open, show that major gaps in data sharing persist despite years of federal policy focused on improving health information exchange.

The survey asked physicians about six data types: medications, allergies, immunizations, problem lists and lab results; and five document types, including consultation notes, imaging reports, outside-hospital test results and encounter summaries. Researchers defined "ideal interoperability" as outside information that is automatically available in the EHR, easy to find and easy to compare or reconcile with a patient’s existing records.

The results show how far data sharing still has to go. Only 19% of the physicians surveyed reported they had an ideal interoperability experience when locating encounter documents from other organizations. And, just 8% said they had seamless access for lab and test results from outside hospitals.

Beyond overall low rates, the study found wide variation in how physicians experience data exchange. Respondents noted that some information, such as medication lists and immunizations, was consistently available. Other data, including specialist notes or outside-hospital test results, was rarely accessible in a usable format. Many physicians reported that even when information did appear in the EHR, it was embedded in long, unstructured documents or scattered across multiple EHR locations.

Physicians also said there was significant workflow strain when reconciling external information with their own clinical records. The study highlighted that usability issues -- not just technical connectivity -- remain a major barrier. Nearly every interoperability measure in the survey depended on whether clinicians could quickly find and interpret outside information during patient encounters.

Context from national reports supports these conclusions. Data from the Assistant Secretary for Technology Policy shows that while about 70% of non-federal acute care hospitals routinely participate in the four core exchange functions (sending, receiving, finding/querying and integrating data), fewer than half of clinicians regularly use outside information during clinical encounters. Even when data is technically available, they cite difficulty locating it or integrating it into their workflow.

The authors of the JAMA Network Open study pointed out that these shortcomings have clinical consequences. Missing or difficult-to-find results can lead to duplicate testing, missed context or delayed decisions, especially when patients transition between care settings.

A 2022 systematic review found that stronger EHR interoperability improves medication safety, reduces patient safety events and lowers costs compared with health systems where data cannot move cleanly across settings.

Further, the consequences may be uneven. Prior research shows that practices serving higher proportions of vulnerable or underserved patients are less likely to report satisfactory interoperability. For patients already at greater risk of fragmented care, missing data may further impair care continuity.

The authors said targeted action is needed to improve the usability, standardization and integration of exchanged data.

"Collaborative efforts that simplify interoperability and more robustly support data standardization and quality are needed to improve system-wide interoperability," they wrote.

They further noted that achieving value-based care, stronger care coordination and better population-health performance depends on giving clinicians timely, usable data at the point of care -- not merely expanding technical exchange capabilities.

Elizabeth Stricker, BSN, RN, comes from a nursing and healthcare leadership background, and covers health technology and leadership trends for B2B audiences.