I expected this past weekend to be devoted to thinking about final MU changes, however my attention was drawn to the announcement about Verizon’s entry into the HIE arena. It appears Verizon has launched a Web-based health exchange, something of which I have been advocating for the past year or so, and teamed up with several other players to make it work.
MedVirginia, a private health exchange operated in Virginia; Medfx, a company knowledgeable in cloud based health care and practice management solutions; and Oracle for its transaction systems, databases and indices. It’s a good model, as it provides knowledge in the practical operation of an exchange and technology necessary to power it across the Web. But it seems to me the new offering — as bold as it is — has missed a critical component. All of this effort is aimed at moving data from one point to another, but where is the skill set to use that data to transform the way providers deliver care, and what metrics will be used to assess quality?
I am encouraged by the Web-based concept in health exchanges — this is a great model. I have long been worried about creating an environment of “have” and “have not” health care organizations where hospitals and groups with the ability to invest in health exchanges do so and those less financially fortunate are left out. A Web-based version of health exchanges will potentially make more organizations players in this endeavor and start to close the chasm. But the goal of health exchanges cannot be just moving data from As to Bs.
Throughout my career, whenever approaching a new project, I would ask three simple questions. What are we going to do? Why are we doing it? How are we going to know if we did it right? It is past the time to ask these questions of the health exchange world. There is a value proposition embedded within HIEs for healthcare transformation. I believe the model includes quality, safety, and efficiency objectives, but I don’t think we are asking the transformational questions. So I am asking the question! Can a telecommunication company help transform the way healthcare is delivered?
When I go to the Verizon healthcare site and select “products” I am presented with a list of telecommunication functions. Under resource center there is an impressive list of case studies and fact sheets again talking mostly about technology — all of which are enticing but none of which map a course to answer the WHY Question. Why are we looking to build health exchanges?
MedVirginia talks about quality, safety and improving efficiency of healthcare services on their public Web page, so I am encouraged that somewhere in the overall offering there is the potential for transforming healthcare , but it seems to me they are looking at the interoperability side of the formula. The why questions needs to be defined out front as part of the reason for entering this business. And it’s not about helping clinicians reach meaningful use. MU is a “how” not a “why.”
Verizon has pulled together most of the pieces it needs to build a HIE infrastructure, but they need to go deeper. Like the rest of us, they need to ask the prudent question. Why should we build health exchanges and what is the value proposition therein?
We need to build a health exchange to change the way healthcare is delivered. The HIE is an avenue to deep and significant changes in the way clinicians practice medicine. It is part of the effort to modernize the healthcare delivery system and, by so doing, create new opportunities and methods for delivering care. Firstly we need to improve the infrastructure. Infrastructure improvement is the rationale behind ARRA funding. It does not matter if it is roads, energy grids, libraries or healthcare, ARRA is funding equals infrastructure. And the Infrastructure behind healthcare is connectivity and EHRs to create an environment when health information can be shared electronically.
The second level involves providing analytics about the health state of a population for a practice. By using the accumulated clinical knowledge in electronic health record, physicians, for the very first time, can explore the health state of their patients. This positions them to actively work on chronic conditions and begin moving the patient from a chronic to acute disease state. This will be a significant driver to reducing cost. And herein lies the real value of Meaningful Use!
It starts the data collection process and prepares clinicians to be able to ascertain the level of quality being provided, and to benchmark that care at national and regional levels. The regional extension centers will offer some help here but remember their goal is to help physicians reach Meaningful Use. Meaningful Use, especially in its Stage 1 efforts, is only about creating opportunities for behaviors. It is not the end of transformation.
The third level is the transformative state where technology can drive patient involvement in managing disease states. Telemedicine, home monitoring and personal health records all become meaningful and effective ways to keep the patient involved. Healthcare starts to become mobile — a “take it with me wherever I go” approach. Best practice guidelines can be shared, providing structure and knowledge in a very meaningful and specific way for both docs and patients. This is real coordinated care because it involves not only the clinicians but the patient as well.
With the infrastructure growing, the value proposition for HIEs evolves to building the dashboard and metrics which make the exchange of data meaningful. These metrics will be regional, as healthcare is regional. The needs of one community may be different from the needs of another community. Knowing the regional specifics will help to reduce the cost of care and improve quality — what a wonderful tool to have in your back pocket if Accountable Care structures begin to take shape.
Verizon, I think you are off to a good start, now let’s look at the rest of the work to be done. And I fall back to Francis Bacon’s axiom that “a prudent question is one-half of wisdom” and ask: How wise will we be?