- Expectations for health IT companies are rising as a result of the transition to value-based care.
Providers are increasingly experiencing pressure to improve information exchange at their practices and demanding clean, comprehensive, and actionable patient health data. In turn, they are increasingly turning to their technology partners for solutions.
Two panelists representing the Sequoia Project and Epic Systems at the Value-Based Care Summit in Chicago last week emphasized the need for health IT companies — from EHR vendors to health information networks — to meet provider expectations for health IT as part of value-based care models and population health initiative.
“Providers want more data as soon as possible from everywhere a patient may possibly have been treated. But the reality is that the capabilities that exist today on a large-scale basis in our industry simply aren’t sufficient. So I’d say it’s a matter of willingness to take incremental steps,” said Sequoia Project CEO Mariann Yeager.
“There’s a pressing need and demand for the data that I have not seen since we started our initiative,” Yeager continued. “And certainly expectations for the quality of the data is set at a different bar than we’ve ever seen.”
The transition to value-based care and the emergence of population health management have sparked increased eagerness among providers to demand diverse data faster than ever. Health IT companies need to develop products to fit the specific needs of different providers instead of providers adapting to fit the capabilities of new technologies.
While the need for change is pressing, Yeager warned that this evolution will not happen overnight.
“We’re taking incremental steps,” she maintained. “From a network perspective, it boils down to doing more conformist and rigorous interoperability testing of the payload to improve quality and consistency.”
These incremental steps are going to have to occur faster and faster in keeping with the increasing rate of change in the industry.
Health information networks and EHR companies have been able to decrease variability in technology platforms over the course of a few years to improve interoperability. However, these organizations must meet the demands of newer changes such as the burgeoning focus on population health management in the span of a few weeks.
“Networks are evolving so that we need to support more than just clinical documents—we also need to support social determinants,” said Yeager. “I have about two calls a week from somebody supporting a two-on-one program. They want to send referrals to a two-on-one agency that can coordinate getting services for a patient, genomics data, and other kinds of data.”
Vice President of Interoperability at Epic Peter DeVault also cited the demand for different kinds of data as one of the biggest shifts in provider expectations.
“Most provider organizations understand that they have to exchange information and be good consumers of information to survive,” said DeVault. “It is something they are demanding.”
Population health management and social determinants expand the definition of health data several times over.
“We’re talking about getting data from the environment, the climate, from listings of parks, and where there are food deserts, and just a huge variety of information,” he added.
The breadth of health data and the variety of providers demands on their health IT partners will likely continue to increase.
“Even the concept of what we’ve been focusing on within a handful of weeks has broadly expanded,” said Yeager. “That’s very telling.”
DeVault highlighted the evolution of use cases as another big change likely to continue to overtake the healthcare industry.
“We’ve been working on clinical document exchange for more than a decade now, and we’ve mostly gotten good at that even though the document quality isn’t always there,” said DeVault. “But there are other use cases current technology can allow us to tackle.”
These use cases involve a higher level of specificity in the information providers request.
In an effort to maintain a focus on actionable, intelligent health data exchange, DeVault noted that health IT companies need to find solutions to avoid inundating providers with excess or useless data.
“Sometimes, rather than a document, providers just want to see medications the patient has taken, or they just want the conditions,” he said. “FHIR-based APIs are lending themselves to that.”
But even with FHIR-based APIs capable of delivering a higher specificity of health data, significant problems still arise that muddle the clarity and efficiency of data a provider receives.
“For some of our customers, when they’re trying to get the patient medication list, they might get close replicas of that medication list from 7 or 8 different places — from all of the places the patient’s been seen, from the PBM, from the payer, perhaps, or from the patient themselves,” DeVault said. ““It becomes a data science problem to de-duplicate that information and make it useful for a clinician.”
The shift to value-based care and accompanying federal incentives has expedited the need to clean up this data, and new payment models should be key in spurring improvements.
“Aligning incentives creates a demand for the data that we haven’t had yet,” said Yeager. “It’s about figuring out how to elevate priorities to make things work and work better. And that’s where alternative payment models and the new programs will have an impact.”
While health IT companies have a responsibility to keep pace with provider expectations, providers must also to do their part to make informed decisions when purchasing a system.
Speaking on behalf of one of the nation’s top health IT companies, DeVault advised providers to be wary of relying too heavily on health IT certifications.
“The best advice for a provider buying health IT is not just to rely on the certification and on responses to the RFP the vendor provides, but to do site visits and reference calls,” he said. “You have to see it in action.”
That perspective was shared by Yeager whose organization oversees Carequality, eHealth Exchange, the RSNA Image Share Validation Program, and other health IT interoperability initiatives.
“If you want assurance the system is capable of sharing information, you would have a high degree of assurance if that system and technology was widely deployed in a multi-vendor network initiative like Carequality,” Yeager said. “It’s not just that a system out of the box is capable of interoperating — where is the evidence that it is already? That requires a higher bar of testing for not just the movement and the transport, but also the content and the payload.”
If a certain EHR system has demonstrated benefits and has garnered a positive reputation among users, Yeager believes providers will likely have success with the technology.
“It’s about taking that technology and making it real in a real environment — seeing the proof,” Yeager added. “Look where there’s a high degree of connectivity and production exchange in existence and a high utilization, and you’re going to see some winners.”