Ask any doctor if they can freely share digital patient records outside of their organization, or access patient information stored in another organization’s electronic health records (EHR), and the answer is typically a resounding “no.”
This unfortunate reality perpetuates the use of fax and express or postal mail and contributes to frustration and burnout. In a recent study, 56 percent of physicians cited too much charting and paperwork as the primary cause of their irritation.
In 2018, this can and must change.
The Foundation Has Been Poured
With all of the power and efficiency of the internet revolution, as well as the convenience and usability of the mobile revolution, we can achieve what healthcare needs to move information technology practices into the 21st century.
The reality is that the foundational components have progressively fallen into place:
- The standards bodies have created a framework for exchanging health data in a structured way (HL-7, C-CDAs, FHIR, and others).
- The government has driven the adoption of these standards through meaningful use.
- EHRs have been broadly adopted (>95 percent of hospitals and >87 percent of physician practices) and have the ability to extract clinical data and transport it to another EHR system.
- The health information exchanges (HIEs), both public and private, have shown it is technically possible to exchange records.
- The security industry has developed identity proofing, encryption, user authentication and logging capabilities.
- The IT industry has provided capable, reliable and readily available cloud platforms, with security and performance that far exceeds what enterprises can do themselves.
But, despite all of these advances, sharing patient information – both structured and unstructured – remains a burden to clinicians and administrators and makes the task of succeeding as a value-based organization harder than necessary.
I believe “perfection has become the enemy of good,” as IT departments strive to both share and restructure data without an industry-wide, ubiquitous service that brings this all together.
The Goal Needs a Dose of Pragmatism
Creating a perfect consolidated patient record, through deep and expensive enterprise integration, is not a realistic near-term goal. Such an effort would require information on every interaction an individual has had with the health system, including device data, lab data and even environmental data – from cradle to grave.
But putting actionable information into the hands of healthcare providers, in a way that aligns with incentives to improve quality and reduce cost, absolutely is.
With the reach of the cloud, convenience and simplicity of mobility, and power of modern computing, providers could start to enjoy real-time interaction about their shared patients as easily and intuitively as every other industry leverages these tools.
Opportunities in Value-Based Care
According to the Health Care Transformation Task Force, there are now 923 Accountable Care Organizations (ACOs) covering approximately 32.4 million lives. This model is now highly pervasive and potentially impactful on our healthcare system.
So, let’s consider an ACO operating in a metropolitan area with hundreds of independent primary care physicians, specialists, therapists, a handful of hospitals and other tertiary providers. They are open to accepting more risk to increase reimbursements, are working hard to improve the quality of care they provide (and in turn, patient outcomes) but are hamstrung by technology. The smaller providers use various EHR platforms with limited IT capabilities. One of the hospitals was a recent acquisition, and data visibility is almost non-existent between many of the offices and providers.
Without broadly adopting the same EHR platform or undergoing lengthy and expensive integration projects, how can this ACO avoid being overrun with manual processes and inefficient workflows to access and analyze its patient data to drive quality improvements and cost efficiencies?
By leveraging existing healthcare infrastructure gains, and without migrating to a single EHR platform, this ACO can use cloud-based platform capabilities to empower members to share structured medical records and unstructured patient information between and among any facility or healthcare worker and in and out of any EHR. The ACO could then:
- Share – easily and securely – the most clinically relevant parts of a patient record from any EHR system
- Provide a cost-effective vehicle to all members that does not exclude small and/or independent practices
- Allow for free and open communication between all healthcare professionals (including extended providers such as home health workers) about their patients, regardless of the facility they work in
- Solve the practical problems they’ve been facing that impact healthcare cost, quality and patient outcomes, through improved data visibility
Clinicians would then be able to share data with simple and affordable IT configuration of their EHR system – not deep integration – and open lines of communication with any other clinician to get their jobs done. Imagine the change this would bring about, using EXISTING capabilities to, for example:
- Improve the quality of electronic patient referrals by attaching relevant patient data
- Allow existing EHRs to remain in place while improving care coordination
- Identify gaps in care across facilities and providers and drive deeper analytics
- Ease secure clinical communications between providers
The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.
Originally published February 12, 2018