Henry Wadsworth Longfellow once wrote, “Build today a firm and ample base and ascending and secure shall tomorrow find its place.” We CIOs in healthcare have been building a firm and ample based over that past decade. Not that many of us thought in terms of building a foundation when dealing with the hazards and crisis of everyday technology and information management, but a foundation is what we have.
Electronic health records in our hospitals and health systems, online documentation, electronic ordering and billing, e-prescribing and rudimentary clinical decision support are our bedrock. Electronic medical records for physician offices and ancillary services are foundation work currently being fueled by ARRA and REC dollars. Health exchanges are the cement to bring the pieces together. The potential for lowering cost, providing new clinical services, increasing quality and improving patient safety drive us forward. But there is still much work to do.
I have written previously on the three stages of change which healthcare systems need to adopt in order to improve quality, safety and reduce cost. Getting Connected, Getting Smart, and Getting Healthy. Getting connected is the foundation work for the healthcare delivery system to share information. Although underway, the dollars available are limited and we have to be smart about how we spend them. If we look at the amount of money available for HIEs and Physician offices in ARRA, you realize it is not very much. In New Jersey, there is $11.4 million for HIEs and about $2,500 per physician for REC education and EMR enablement. Not exactly a well funded effort.
With this in mind, we need to concentrate on the deliverable, the goal of all this effort. I believe that is the “Get Smart” portion of the stages of change in the next step. Get Smart are the walls to our foundation and takes advantage of digital data to provide clinical decision support. Here, physician and health system have the tools to better understand the services they deliver and understand the cost and quality structure embedded in the delivery of care. For the first time, health systems and physician offices will have a tool to help them understand the nature of the population they treat, review practice patterns to improve delivery and enable a deep dive into the cost structure. All of this empowers us to negotiate better rates with payers as we have the documentation of what is done well within our sphere of influence.
Getting Healthy however is the area in need of more effort and definition. Getting Healthy is collaborative care. It constructs the roof to our foundation and walls by providing the knowledge and power to move patients from chronic care to acute care which, I suspect, is the area with the greatest financial advantage. This, more than anything else, is the change the American health system needs to get cost under control. Unfortunately, Collaborative health software is not as robust and available as the traditional EHR solutions with which we are familiar. Most clinical software has been designed to document and code an encounter. This is not enough. We need to have software which monitors an episode of care at the very least. We need tools that facilitate collaborative effort, specifically the ability to have multiple caregivers’ access and update patient data at the same time. This seems simple but, in a busy practice, it is a critical component not available today.
Collaborative health demands the ability to reconcile medications from multiple providers. Today’s systems provide for a single physician view of the medication they provided, but that is not necessarily all the medication the patient is taking. Consistent with this theme is the ability to aggregate laboratory, radiological, and consultative information. The lack of a national patient identifier is one component contributing to the difficulty of this functionality, but it may also require a change in privacy laws. Additionally, a collaborative tool must normalize lab results from different parties which may use different reference ranges and names of tests. I potassium for example is not always a potassium.
Most glaring is the lack of an integrated personal health record. If a collaborative environment requires the patient to be an active participant in care, they must have access to the same clinical information as the caregivers. This demands a tool to help understand result ranges and translate diagnosis and treatment options into “layman’s terms.” Not something readily available. Having all these pieces and integrating them is the challenge we face, and very few tools are available in the market to assist with this effort.
Getting Healthy is where we have to go. Collaborative healthcare is the tool we need for the ascending and secure future the healthcare system needs. I would like to hear your thoughts on how to get there.