EHR Interoperability Experiences Reported by Family Physicians.

Importance: Improving the interoperability of electronic health records (EHRs) is a core health care policy goal and an important enabler of high-quality continuous care. Objective: To describe the extent to which primary care physicians have ideal interoperability experiences and simulate the potential impact of interventions to improve those experiences. Design, Setting, and Participants: This cross-sectional study leveraged the 2024 American Board of Family Medicine Continuous Certification Questionnaire, fielded November 2023 to October 2024, to conduct a survey of family physicians about their interoperability experiences. To estimate the impact of hypothetical interventions, responses to individual survey questions were artificially modified and the impact on rates of reported ideal interoperability experience were observed. Data were analyzed from October 2024 to January 2025. Exposures: Principal practice size, ownership, EHR system used, gender, age, urban vs rural location, and physician-reported percentage of patient panel who are vulnerable and who are value-based care patients. Main Outcomes and Measures: Outcomes of interest were reported ideal interoperability experiences for 6 data types and 5 document types, with ideal interoperability experience defined as often automatically obtaining information, easily finding that information, and easily comparing or reconciling it, all within the EHR. Results: A total of 8122 family physicians responded to the survey (100% response rate), with 2336 respondents (29%) working in independent medical practice. Physicians' reported ideal interoperability experiences varied by data type, ranging from 19% for encounter documents to 8% for test results from outside hospitals or health systems. Illustrative simulations showed that interventions that increased the proportion of physicians who reported often automatically obtaining medications by 20 percentage points increased the proportion of physicians reporting ideal interoperability experiences for medications by 1 percentage point. In multivariate regression models examining ideal interoperability experiences by practice characteristics, physicians with vulnerable patients representing more than half of their panel were less likely to report ideal interoperability experiences for primary care notes and consultation reports from independent practices (odds ratio, 0.66; 95% CI, 0.48-0.91) but not for medications (odds ratio, 0.96; 95% CI, 0.73-1.27). Conclusions and Relevance: In this cross-sectional study, family physicians indicated that despite public policies designed to ensure that EHRs support standards-based data exchange and incentivize clinicians to engage in exchange, these policies had not fully translated into widespread interoperability for all use cases. Collaborative efforts that simplify interoperability and more robustly support data standardization and quality are needed to improve system-wide interoperability.