- The digital picture of a patient’s health is incomplete unless it includes electronic information from all clinical encounters with healthcare providers from primary to specialty care. The challenge of creating a comprehensive electronic health record requires two components: an EHR system capable of both documenting care robustly and exchanging health information seamlessly with other EHR and health IT systems.
In light of all the talk of interoperability in healthcare, particularly in health IT circles, it is easy to misconstrue the challenge of making systems speak the same language as being a purely technological one. The problem with that perception, however, is that it doesn’t encapsulate all the forces at play.
“The challenge is not so much a technological one as it is overcoming policy and business challenges,” says Amanda Parsons, MD, MBA, Deputy Commissioner of Health Care Access & Improvement for the New York City Department of Health and Mental Hygiene.
At the upcoming Hospital Cloud Forum in New York City on April 16, Parsons and numerous other speakers and panelists will discuss how healthcare organizations and providers can move from meaningful use to meaningful outcomes through the increased and innovative use of EHR and health IT systems.
Currently, Parsons and other officials are focused on promoting health information exchange (HIE) in the State of New York, an effort which has revealed a variety of barriers to exchanging health information beyond technical infrastructure. One significant obstacle is getting healthcare organizations other than hospitals to see the value in using regional health information organizations (RHIOs) or similar entities for HIE:
RHIOs are really interested in providing services to hospitals, but small primary care practices are a relatively unattractive market for the RHIOs. Those smaller practices have far fewer resources and a low willingness to pay for RHIO services, particularly because there isn’t yet sufficient in those RHIOs. So we’ve got a chicken and egg situation. Providers don’t see value so they don’t join, but there won’t be value until enough of them join and contribute data.
Clinician buy-in plays a vital role in the adoption of EHR and health IT systems. Apparently, HIE is no different, but in this case the buy-in refers to getting the full spectrum of providers onboard with exchanging health information.
So what role does government play in fostering meaningful exchange of health information and driving HIE forward? And what will it take to get these small practices to adopt HIE? According to Parsons, it’s less a task of legislating change and more of assuming the role of facilitator, bringing the right combination of stakeholders around the table and then building trust among them.
“In terms of innovations and breakthroughs around data exchange policies, I definitely think that the process NY State is undergoing, working hand-in-hand with the major stakeholders around the table, is the right approach,” explains Parsons. “Somebody once said, ‘Data moves at the speed of trust,’ and we really do need to get the trust around these data exchange policies. As slow as it is, I do see why we’re doing this a statewide collaborative process. You can’t dictate trust.”
While the exchange of health information represents a top concern for Parsons and other officials in the state, it only becomes meaningful if the information flowing through it is useful to providers. And that is not possible without advancements in EHR design and adoption:
We’re not going back to paper records. That was a terrible alternative. Paper isn’t safe. It isn’t secure. It doesn’t support clinical analytics. But EHRs need to become more robust and solve more complex problems. Frankly, they can’t just be about organizing the data in a single doctor’s office. We’ll get tremendous value out of them when they can appropriately incorporate and display external data about the patient, run sophisticated algorithms to prompt for evidence-based interventions, and can help providers understand more about the health of their overall patient panels.
Just as policymakers must work in concert with healthcare providers and health IT developers to foster a culture of innovation and exchange, so too must EHR adopters and HIE organizations collaborate to ensure that providers and patients see benefits from health IT in the form of better outcomes through improved care coordination.