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By Monica E. Oss

Over the past decade, the rapid adoption of electronic health record systems has revolutionized the health care industry, but the promise of better care, improved outcomes, and lower costs has not yet been fully realized. Challenges with interoperability, the ability to exchange information electronically, hinders clinicians and patients from obtaining medically relevant, actionable, and usable data to inform treatment decisions

This quote is from a letter Ben Moscovitch, Manager, Health Information Technology of The Pew Charitable Trusts sent to the Office of the National Coordinator for Health Information Technology in January (see Letter To The ONC). While the letter has a specific recommendation—requiring electronic health records (EHR) to grant patient-facing APIs access to more information than what is in the Common Clinical Data Set (CCDS)—it was the reference to the lack of “medically relevant, actionable, and usable data to inform treatment decisions” that caught my eye.

I think we’re in the midst of a major transition of the use of technology in the health and human service field. A decade ago we were in the finance phase—most of the technology infrastructure was focused on billing for, and payment of, services. Then, enter “meaningful use” and the requirement that all providers have an EHR—the compliance phase. I remember the keynote presentation by Richard Hillestad, Ph.D., senior management scientist at The Rand Corporation, at the first OPEN MINDS Technology & Informatics Institute, in November of 2005. At the time, EHRs were in use in approximately 20-to-25% of hospitals, and 10-to-15% of physicians’ offices. He estimated that there would be “billions” in savings from EHR adoption—in system productivity, better treatment allocation, and improved outcomes. But with one important caveat—that the net savings would accrue to payers, while provider organizations would bear the majority of the costs. Over the past 13 years, that has proven to be the case (see Can Information Technology Transform Health Care?).

Where are we now with EHR adoption? Eighty-four percent of specialty provider organizations with revenue over $25 million, and 75% of organizations with revenue below $25 million, have an EHR (see The Impact Of Tech In The Future – & The Reality Of Tech In The Present). About 80% of 150 largest non-profit senior living facilities have an EHR, and nearly 30% of these communities have an advanced EHR that can participate in information exchanges (see 30% Of Large Non-Profit Senior Living Facilities Have EHR With HIE Capabilities). And nearly all reported specialty hospitals (96%) possessed an EHR in 2015 (see 96% Of Acute Care Hospitals Have Adopted Certified Electronic Health Records).

But, I have found that in my discussions with clinical managers at almost any level, their view of their EHR is one of “must do” rather than “must have.” Many clinical managers find the time spent with the EHR does not usually result in information and functionality that improves their work. And consumers have yet to see meaningful benefits from the large national investment in health care information technology. This sets the stage for the next phase of EHRs—the service engagement phase.

For competitive advantage in the years ahead, health and human service organizations will increasingly need to compete for the best staff members and for consumers. This means reengineering information flow to make the work of team members more productive, while engaging consumers and caregivers. To the first point, making team members more productive, my colleague Sharon Hicks wrote about adopting the “Quadruple Aim” a few years ago—including clinical team member satisfaction and quality of work life in planning (see To Hit The ‘Triple Aim’, You Need The ‘Quadruple Aim’).

Jim Gargiulo

To the second point, how health and human service executives can reeingineer the flow of information for consumers and caregiver, I reached out to OPEN MINDS Senior Associate Jim Gargiulo, who noted:

Reengineering how we use information to improve work flow and engage consumers has proven to be a major challenge for the health care industry. Unlike other industries that have been able to harness the power of consumer-centric data, interoperability has failed to meet its promise in health care. The most obvious example is in personal finances – I can send or receive money anywhere in the world, adjusted for rates of exchange and transaction fees through the simple use of a pin number without too much worry about its security. It’s on-demand, and it’s cheap and reliable.

In health care, on the other hand, outside of the primary care provider, consumers remain secondary to the information chain. Over the years, interoperability has evolved from point-to-point batch interfaces, to HL-7 standards, to a variety of HIPAA transaction standards, and finally to the Continuity of Care Record (CCDS); all with the intent of connecting provider organizations together and connecting providers to payers, but not consumers to their data. This payer-provider focus continues with the growth of health information exchanges (HIE), application programming interfaces (API), and robust industry initiatives such as CareQuality, Commonwell, and others. The Commonwell Alliance is looking in a new direction, promising consumers a new health care experience with:

  1. Better care coordination with primary care professionals, specialists, care managers and more—having more secure, near instant access to health information.
  2. More informed care—with less time wasted tracking down test results and other health information, health care providers can spend more time focused on care.
  3. Support in case of emergency—when medical staff could immediately access allergies, medications and health problems, helping them provide care without delay.
  4. Reductions in paperwork and hassle—tied to the inconvenience of filling out the same health history forms over and over when new doctors are involved and are in the CommonWell network. The latest health information will always be there.

To make an impact on consumers, interoperability needs to move beyond the traditional standards and align with person-centric care. Given the terminal uniqueness of behavioral health and human services providers, standards have devolved into lowest common denominator data sets, serving primarily providers and payers, and reflecting only the tip of the iceberg of the information needed for improving the lives of people living with complex conditions. More data and more comprehensive data integration, perhaps through the emergence of blockchain and the greater availability of API’s across the vendor community holds more promise. But it can only happen if the vendor, provider and payer communities break down data silos among themselves. In the end, interoperability needs to move towards data transformation and integration, perhaps taking the examples from the experiences of other industries and applying them to the user health care experience.

There is certainly growing consumer concern about the data privacy in the wake of the recent health care data breaches—and the Facebook election scandal. But, despite these concerns, consumer appear to continue to be willing to trade privacy for convenience. This is a balancing act for health and human service organizations.

For more OPEN MINDS coverage of HIE, check out these resources from the OPEN MINDS Industry Library:

  1. HIPAA, HIE & The Art Of Sharing Information
  2. IT Spending Follows The Money
  3. Technology Moves From Compliance To Strategic – The Three Tech Mega Trends Of 2017
  4. Is Your EHR Up To The Challenge Of Value-Based Reimbursement?
  5. ‘Person-Centered’ Health Care Records Take Center Stage
  6. Summary: 21st Century Cures Act Of 2016
  7. FDA Urges Advancement Of New Digital Health Policies
  8. Number Of Health Care Consumer Records Compromised By Data Breaches Dropped 80% In 2017
  9. The Missing Numbers
  10. More & Larger Health Care Databases Mean More Data Security Concerns

For more on the changing discussion on data management and access in the health care landscape, join me on June 5 at The 2018 OPEN MINDS Strategy & Innovation Institute for the session, “Data Sharing & Security: Challenges & Best Practices”, featuring: Michael Jarjour, President & Chief Executive Officer, ODH, Inc.; and Rubén King-Shaw, Jr., Chairman, President, & Chief Executive Officer, MedicFP.

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