# Health interoperability across phenotypes of family physician practices

## TL;DR

The study explores how different types of family physicians in the U.S. experience healthcare data interoperability, finding significant differences based on practice type and EHR usage.

## Contribution

The novel contribution is identifying four distinct physician phenotypes and their differing interoperability experiences, particularly highlighting disparities in EHR integration and usability.

## Key findings

- Health system and large practice physicians had better EHR integration and usability compared to independent and safety net physicians.
- Safety net physicians were least likely to find external information usable, with only 17% reporting usability.
- Across all phenotypes, 42-50% reported encountering external records with low-value information.

## Abstract

To inform initiatives to improve the interoperability of healthcare data, we described the experience of distinct phenotypes of physicians when obtaining information from outside sources.

A total of 6175 family physicians across the United States responded to information technology questions on the 2022 and 2023 American Board of Family Medicine Continuous Certification Questionnaire (100% response rate). Latent class analysis grouped physicians by individual and practice characteristics and then compared reported experience with interoperability.

A 4-class model (“Safety Net,” “Health System,” “Independent Practice,” and “Large Practice”) best fit. Health system and large practice physicians (predominately Epic users) were more likely to report information was integrated in their Electronic Health Record (EHR) than independent practice physicians (38% and 40%, respectively, compared to 24%), and to report that information from organizations using the same EHR was usable (52% and 51%, respectively, compared to 25%). Safety net physicians were least likely to report that information from outside organizations was usable (17% compared to 23% of independent physicians). Between 42% and 50% of each phenotype reported commonly encountering external records with a large volume of low-value information.

Independent practice and safety net physicians reported worse experience in some dimensions of interoperability, likely driven by differences in access to information from organizations using the same EHR. Many other challenges were consistent across physician phenotypes.

Initiatives to improve interoperability among physicians may be most effective if targeted at independent practices and safety net practices; however, broad improvements will be necessary to address similar challenges across phenotypes.