Electronic Medical Records Retrieval Myths: Common Challenges and Misconceptions

In the rapidly evolving world of healthcare, technology plays a crucial role in shaping patient care and outcomes.

As of 2021, 88% of hospitals send and obtain patient health information electronically by querying or electronically receiving medical records.¹ This increased adoption of electronic retrieval has led to electronic medical records (EMRs) being used in operations beyond record storage, such as quality improvement and risk adjustment.

However, providers across the U.S. are not moving in unison in how they use, code, and store information, resulting in healthcare professionals not getting the correct information they want when they need it.

In this blog, we'll explore some of the most common misconceptions surrounding electronic medical records retrieval and debunk the myth that all EMR connections are created equal.

Misconception #1: Direct EMR access is enough

Providers have different EMR systems. While there are some major vendors in the EMR space, they do not account for all the primary care and specialty care providers, where data for quality improvement and risk adjustment are mainly captured.

Depending on the provider type, a specialist may practice in different settings, such as a doctor's office or a health system, and can use more than one EMR to enter patient data and results.

Another factor to consider is data quality. Access to an EMR does not equal usable data for all use cases. Some examples of unusable data include:

• Rendered information inconsistencies

• C-CDAs (Consolidated Clinical Document Architecture) missing electronic signature or signature date

• Missing face-to-face encounters and dates

• Formatting issues with foreign text/symbols

A good question to ask when determining data quality is, "Are there quality checks that my EMR vendor puts into place?"

Misconception #2: Data exchange vendors and HIEs are all I need

Another proven way to retrieve records is using health information exchanges (HIEs) and data exchange vendors.

An HIE allows doctors, nurses, pharmacists, and other healthcare providers to access and securely share a patient's vital medical information electronically. HIEs can be at the community or state level and vary depending on the type of exchange they use.

Similarly, data exchange vendors operate like HIEs but are not constrained by geographic limitations or networks. They will focus on integrating with large health systems with significant patient volume. However, these vendors may be limited by scale as they need to go to each individual location to establish contractual and technical connections.

One key consideration with HIEs and data exchange vendors is that they face quality assurance (QA) issues. Since they're a network of various EMRs, HIEs and data exchange vendors will have QA challenges unique to the providers and EMRs in their network. It's essential for health plans to understand how HIEs and data exchange vendors conduct QA when receiving data from multiple EMRs.

The bottom line is that connecting to a couple of state HIEs and larger data exchange vendors will help, but it may not be "all-encompassing."

Misconception #3: TEFCA and QHINs are the "silver bullets"

Since its launch in 2022, the Trusted Exchange Framework and Common Agreement (TEFCA) has made great strides in creating a nationwide exchange for providers, patients, health plans, and other stakeholders in the care community to exchange information.

The Trusted Exchange Framework details standards that networks must follow when sharing data, and the Common Agreement is a legal agreement that governs data sharing between networks.²

In 2023, the Office of the National Coordinator (ONC) named the first six Qualified Health Information Networks (QHINs) that support, at minimum, HIPAA-covered transactions for treatment and patient access.³ This means that requests for records from other providers or patients must be fulfilled. Currently, other covered transactions relating to health plans are optional, but expansion is coming soon.

While there is hope and belief that TEFCA will help relieve pain points of clinical data exchange in the healthcare community, a nationwide exchange takes significant time to roll out, get adopted, and gain penetration within the industry.

TEFCA participation is currently voluntary. Despite this, experts believe that the advantages of joining TEFCA may be a significant reason why health plans continue to participate and more will join in the future.

While QHINs will be another powerful tool in a health plan's toolbox, they may not be a "silver bullet" for all medical records needed, given TEFCA's rollout of mandated use cases.

Misconception #4: There's a "one-and-done" electronic medical records retrieval solution available

There is no "one-size-fits-all" solution for retrieving medical records. Instead, health plans need a multipronged approach.

The end goal is to electronically receive every record for every member, and the healthcare industry is working toward it. Right now, for health plans to electronically receive medical records for their members, they need to contract with EMRs, HIEs, and data exchange vendors to gather enough data to drive significant efficiency and cost savings.

Health plans must dedicate teams, IT, and financial resources to manage and maintain the various connections. Even with contracts and agreements, there may be gaps when exchanging EMRs between different networks.

Is there a solution that can handle the complexities of electronic medical records retrieval?

Health plans use medical record information in multiple ways, including prior authorization, care management, payment integrity, HEDIS® reporting, and risk adjustment. Not all EMR vendors have the same connectivity across use cases. For example, HIEs in certain states make exceptions for record retrieval under HEDIS but not for risk adjustment.

Fortunately, there is a way to handle the complexity of electronic medical records retrieval. Inovalon has the experience and nationwide connectivity to be a powerful tool in a health plan's multipronged approach when sending and receiving medical records.

Inovalon's Electronic Record On Demand eliminates the complexity and burden of traditional medical records retrieval with a SaaS-based clinical data extraction software that delivers industry-leading connectivity, speed, and cost savings. This solution takes advantage of Inovalon's extensive connectivity to EHRs and HIEs and massive proprietary datasets containing more than 392 million unique lives and 84 billion medical events.⁴

To learn more about Electronic Record On Demand, schedule a demo.

¹ "Interoperability and Methods of Exchange Among Hospitals in 2021," HealthIT.gov, January 2023.
² "Everything you wanted to know about TEFCA (but were afraid to ask), Healthcare IT News, January 27, 2022.
³ "HHS Names First Six QHINs to Participate in TEFCA," Healthcare Innovation, February 13, 2023.
⁴ Data from Inovalon's MORE² Registry® as of August 2024.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Inovalon and design®, Inovalon®, and the Inovalon ONE® Platform are trademarks of Inovalon, Inc.

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