No one can reasonably deny that EHR adoption and meaningful use participation have been a struggle. From the patchwork of health IT systems that need to be wrangled and replaced to the payment reforms piggybacking on a revolution in how providers and lawmakers view quality care, the healthcare landscape is changing at a lightning pace, and it’s not always easy to keep up. Dan Riskin, MD, CEO and Co-Founder of Health Fidelity, believes there’s a lot of work to be done in order to improve the provider experience and the patient’s outcomes, both of which rely on making better use of technology and the data it produces.
What needs to be improved about the healthcare experience?
I think it’s tough out there for providers. The government has forced a huge spend on infrastructure, and the providers haven’t seen a lot of benefit. All they have today is a decent input tool, which is the EHR. But they don’t have tools to help them to improve care, reduce costs, or have a better experience. When you look at individual stakeholders, the patient wants better outcomes. The doctor wants a better experience in delivering care.
That translates to a bit of better outcomes and a bit of just workflow, which is all front-end energy put into the system. So the doctor right now spends a very long time using templates and drop-downs and click boxes to try to get information into the system, and it’s a horrible experience.
How can organizations change the way they’re dealing with data?
We have a number of tools coming down the pike to make better use of the clinical record. Natural language processing (NLP) can take that broad, unstructured text and make it usable. Ontologies make the information coded and make it look a lot like claims data, actually. Data mining and other analytics show the health system what they should be doing and what can be done better than what they can do manually. So that combination is really becoming best practices. Right now you only see it in the top few health systems, but I think there’s broad agreement that this will diffuse over time to the less-funded or systems with less expertise.
What have we learned from meaningful use so far?
The lessons we’re learning from meaningful use are related to the mistakes of the past, and the sins we committed when we thought we knew what we were doing with data over the last decade. Meaningful use is just a patch to fix all the things that happened when we allowed hundreds of EHRs, and allowed them to store information in fields that were poorly labeled and database structures that were poorly aligned. When we allowed that to happen, we undermined the future of healthcare data. So now, how can we improve that? There are two parts to that question: quality and interoperability. That’s the interoperability piece.
The quality piece is slightly different. The quality piece says that we really don’t know how to represent quality yet, and we’re trying to learn. That’s actually incredibly powerful. We’re trying to break new ground. If we can represent quality well, then we can start to improve it. The meaningful use goals are kind of minimal, but they’re broad. They’re intended for a wide audience. If you look at the smaller health centers, they’re just barely able to get close to meeting them, and they’ll do that through minimal infrastructure like their EHRs. If you look at the top health systems, they’ve gone well beyond them, and they’re doing it through their data warehouse. They figured out the fifteen quality measures a long time ago, and now they’re on to thirty or fifty of them. So there’s this broad spectrum.
Are accountable care organizations (ACOs) a helpful solution?
I often separate out payment reform from data reform. ARRA and HITECH and meaningful use are all data reform. They’re geared towards getting information into the system, having people on EHRs, having initial quality measures reported, and making sure that we get the data we need. Payment reform is all about giving people incentives to use the information. The thought being that if we subsidize the information so they have it, and then we give them incentives to use it, then that will be a good thing.
ACOs are far more in the payment reform area. It has data reform components, and it’s trying to use meaningful use and get more quality out of it, but it’s mostly about saying, “Listen, if you believe you’re one of the top health systems, then put your name down, sign on the dotted line, and we will allow you to share risk. If you really are as good as you think you are, and you’re using data well, then you’ll improve outcomes and reduce costs. You will win. And if you’re not as good as you think you are, well at some point, you’ll lose.” Right now the risks they’re taking are not very high. But over time the risk level will gain, and they’ll really have to be as good as they think they are.
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