Electronic Health Records

Finding the value in HIE, IT integration will push adoption: Q&A

“What’s in it for me?” isn’t an unreasonable question when it comes to healthcare information technology.  Providers are being asked to spend hundreds of thousands of dollars on new IT systems, and finding the business case for these massive investments is crucial to spurring adoption and improving healthcare at its core.

EHRintelligence.com spoke to Shahid Shah, a health IT integration expert with more than 22 years of experience in EHR development, medical device integration, and technology strategy, to examine the barriers to cost-saving integration and discuss the solutions to some of the fundamental problems plaguing the healthcare industry’s shift to the digital age.  Shah will also be speaking on the topic at this month’s Health: Refactored conference on May 13 and 14 in Mountain View, California.

What are the biggest barriers to health IT integration?

The biggest barriers are probably not technical: they’re primarily in policy and governance.  In the past 20 or 30 years as EHRs became somewhat more common, many CIOs and CFOs and CEOs signed deals with their EHR vendors that basically prevented important integration capabilities without the vendor’s permission.  It would be as if we bought Microsoft Office software and then we had to ask permission from Microsoft to share a Word document or Excel spreadsheet.  If I wanted to send it to you, I’d have to call up Microsoft and say, “Hey, can I send this to someone?” So from a data policy and governance perspective some shops are in pretty bad shape.

Another problem is the fiction being promoted that health data is so complex to integrate that we need to have custom healthcare-specific tools for everything.  For example, there’s a big myth in the healthcare community – and the vendors are promoting this myth so you don’t just go and use any tools you want to – that says you need to have a ton of HL7 technology, and a ton of healthcare expertise before you can do any integration.  It’s the myth of complexity that makes people wait for their vendors because they think data integration is so hard that only their EHR vendors can solve the problem for them.

What about health information exchange?

HIEs haven’t really taken off as fast as they should have.  Really, if you think of HIEs, it’s another area where healthcare likes to give it a special name.  In every other industry, an HIE is simply referred to as a value added network (VAN).   If you call it a health information exchange, it makes it sound altruistic.  It doesn’t matter what industry you’re in: nothing altruistic is going to be profitable or survive for long.

Patients absolutely want all of their data, but there’s very little actual patient demand – meaning very little in terms of data that they’re willing to leave their providers or their hospitals for if they don’t get it.  We believe they want their data, but the demand just isn’t there.  Patients aren’t going to pay for it, and they’re not going to leave a practice unless they add that capability.  So we have a general sense that it’s a good thing to have health information exchanges, but there’s very little long-term sustainable business profitability behind it that would really make it a value added network.

That being said, what we are finding is that our move from fee-for-service to more value-driven care where now the participants all connected up will create a scenario where the participants are saving more money by being in a value added network.  In this new value-driven world we’re going to see that these HIEs will make some headway.  Not because it’s going to be good for the patient, per se, but because it’s going to be good for the providers.

How is meaningful use helping or hindering these efforts?

At this time, meaningful use is creating false demand, which means that the market is distorted in favor of things that the government wants to see rather than what the market will actually bear naturally.  Any time you pump tens of billions of dollars into anything, markets are going to move.  But the question is what happens when those billions of dollars go back out of the system.  Do the markets continue to move, do people continue to do the things CMS has incented them to do?  The answer is generally going to be no.

If all CMS did, instead of pushing meaningful use, was incent people to share data – if they simply defined the data and provided the actual definitions of how that data (the actual file formats) should be created and that the data must be moving back and forth – we would have solved all these problems two or three years ago.

People forget that back in the late 90s when the first version of HIPAA came out, it was more about creating an electronic interchange of billing information.  There was probably 20% penetration of practice management systems before HIPAA and then Medicare said that within a couple of years they would not accept any claims that weren’t coming electronically.  That’s all they had to say.  There was no incentive money, no billions given out, nothing.

Once they established that they were not going to pay non-electronic submissions, guess what happened?  Practice management went from 20% to almost a 95% implementation rate within a few short years. There was plenty of consternation, but it had to be done because paper-based claims were too expensive. If CMS used the same model and said “we’re not going to reimburse for anything without a full clinical record, a full lab record, a full this and that in an electronic form,” they would have solved the problem faster and will much less cash in a jobs bill.

How do we fix these problems?

The fix is that we’re going to have to look at accountable care and the ACA’s primary push, which is value-driven care over volume-driven care.  And now with value driven care, everyone is a partner with each other.  These partners are going to get together and do what partners naturally do, which is come to an agreement and work on governance.  If the communities are putting together their own small HIEs and value added networks without waiting for the government – then you’re going to reduce the complexity of integration and make it very possible to build these value added networks.

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