Déjà vu All Over Again – Trends in Health IT and Information Exchange for 2018 Part 1
December 8, 2017
Brian Mack, Marketing & Communications Manager
As is the case with most adults, particularly those with teen and young adult children, I marvel whenever I come in contact with a newborn baby. Looking at my own 15-20 year old children, it’s hard to imagine that they were EVER that tiny! On those occasions, my advice to the new parents is always the same. “Don’t blink!” I say; the days seem long, but the years go by WAY too fast!
As we approach the end of another year and prepare for the next trip around the sun, part of me is struck by that “gone too fast” sense of whiplash. But as I pause to look back over where Health IT (and Health Information Exchange in particular) has been over the last 11 ½ months, and consider what priorities will command our attention in the year to come, the dominant sensation is déjà vu. Are we really still talking about “Interoperability” and “Big Data”? In the words of the Magic Eight Ball, “Signs point to YES”.
What follows is the first of a two-part series – 3 of the 5 trends that Great Lakes Health Connect anticipates will continue to be part of our business focus in the year to come.
The March from Volume to Value Continues
Regardless of our political leader’s inclinations or the uncertainty that continues to surround the Affordable Care Act (ACA), the broad systemic transition from volume-driven, fee-for-service healthcare delivery to a value-based, Triple Aim driven approach to care will continue.
The simple fact is that the massive financial and human resources that have been invested into transforming virtually every aspect of how healthcare is delivered and received across the country makes it clear that there is no turning back now. While difficult to estimate, approximately $30 Billion was paid to providers to supplement EHR implementations between 2010 and 2015. This investment is viewed largely as a success. According to research published by the U.S Dept. of Health and Human Services, as of 2016, 95% of eligible hospitals had met Center for Medicare & Medicaid Services EHR Requirements. As of 2016, 67% of all office-based providers met CMS EHR requirements. (www.dashboard.healthit.gov/quickstats/quickstats.php)
There is broad agreement that Health IT is integral to achieving REAL transformation in healthcare delivery. Even with the frustration frequently expressed by providers over their unwieldy EHRs, no one is suggesting they would rather go back to the days of paper charting, incomplete information, and wasteful redundant testing.
HIE Consolidation & Continued National Emphasis on “Interoperability”
The “Wild Wild West” days of Health Information Exchange are largely behind us. The industry has settled into three dominant means of interactive electronic health information sharing:
- Multi-Stakeholder – A patchwork of public and private Health Information Exchange organizations, whose approaches, capabilities, and scale vary from state-to-state. The significant advantage that these organizations possess is close relationships with local providers, and an intimate knowledge of the unique workflows that exist in their communities. Regional health information exchanges do the hard fundamental work of creating point-to-point interface connections from provider to provider, and integrating disparate record systems, regardless of where a provider sits within the continuum of care, or what EHR system they subscribe to. Great Lakes Health Connect falls into this category.
- Enterprise – These predominantly vendor driven initiatives allow providers who subscribe, regardless of health delivery organization, to access a patient’s electronic records. Epic dominates roughly 26% of the acute care hospital EHR market (Cerner is just behind with just over 24%), presenting obvious benefits for information sharing among Epic’s customers. The shortfall comes for the overwhelming majority of the market who DO NOT subscribe to Epic or Cerner, and are therefore limited in their ability to access and share critical patient data.
- National – Similar to Enterprise-based solutions, these efforts are also largely vendor-driven and in general ignore a glaring reality. Being that there is NO common national standards for data access, patient matching, or a revenue model that all states, health systems, and providers can either agree on and/or meet. This HIE model is known best by the efforts of CareQuality and CommonWell.
Another dominant national initiative is DirectTrust. The Direct standard-based framework for data exchange is a national secure messaging network that allows providers to engage in a certain level of health information exchange with little extra infrastructure investment or training. However, the capacity of DirectTrust’s technology is very limited, giving providers little flexibility in what information can be shared, or how it is presented.
The ultimate goal of Interoperability should not be to encourage providers to pursue solutions that just meet arbitrarily defined, government mandated, data sharing requirements. The purpose of the technology is to have a tangible and quantifiable positive effect on Triple Aim goals (without adding an undue administrative burden to providers that takes their attention from delivery of care to patients). It is clear that this topic will continue to be top of mind across the industry in the year to come.
Redefining the Meaning, Role, and Value of Health Information Exchange
The term “Health Information Exchange” no longer adequately describes the breadth and depth of services and solutions that are available in value based healthcare delivery environments. Organizations like GLHC across the country are integral contributors, conveners, collaborators, and facilitators of care delivery. Regardless of the finance model or payer source, the savings required to make healthcare transformation successful cannot be achieved without the seamless integration of patient data sharing technology.
We utilize technology, but we work with humans. No technology in the world can solve the problems created by widespread healthcare and population emergencies, such as the aftermath of natural disasters or the Flint Water Crisis.
Community based “clinically integrated networks” like GLHC are uniquely positioned, with the provider relationships and understanding of local dynamics, to effectively overcome challenges that inhibit successful sharing at the point of care. At the same time, through initiatives such as the Heartland Project, we are demonstrating the capacity and scalability of a viable answer to the question of national interoperability, by leveraging the Patient Centered Data Home concept.
Our challenge and opportunity as we move into 2018, will be to clearly delineate and communicate the many ways that we can add value to the provider community, that are beyond our historical core competencies of building integrated point-to-point connections and facilitating health data transactions.