Monday, 23 November 2015 20:15

VBP and Interoperability

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One of my lab results recently raised my internist’s eyebrows, so I visited the specialist she recommended. The specialist told me that in addition to the single value he’d been faxed by my internist, he needed results from as many past tests as possible. Here is how he told me he would get them: “I’m writing a note to my staff to have them ask your internist’s office to fax over the results of your earlier tests. I’ll take a look and call you next week. If you don’t hear from me by the end of next week, please give me a call and leave me a message. Sometimes my staff forgets, or her staff forgets, or I forget.”

This is how, in the 21st century, many caregivers in our $3.2 trillion industry communicate in what could be matters of life and death. How long has it been since anyone but healthcare providers routinely shared information this way? I’m mostly involved in the strategy, planning, and management end of healthcare consulting, but sometimes I need access to claims or clinical data. In those cases, my clients provide secure, HIPAA-compliant VPN data access. As for faxing, I’ve used the fax function in my all-in-one printer a total of three times in the past two years. Yet providers are still faxing important client information back and forth, and relying on notes to staff, voicemail, and patients themselves to ensure that the faxes get sent.

It isn’t that these physicians don’t have electronic health records (EHRs). They both participated in the Medicare EHR Incentive Program and attested to meaningful use, so the taxpayers footed most of the bill as they chose and adopted an EHR. The problem is that their EHRs don’t have “interoperability.” That is, they can’t exchange information directly and without special effort.

Obviously, having easy access to patients’ medical history across all providers can help any caregiver make better treatment decisions. But that access is key for caregivers participating in value-based purchasing (VBP) programs. To the extent you are penalized or rewarded for the outcomes of the care people receive, you need a cost-effective way to manage and coordinate that care. Or if, like accountable care organizations (ACOs), you’re unable to manage completely where the population receives care, you at least need cost-effective access to data that can tell you all about the what, when, and outcomes of the care your patients received outside of your control.

As my own experience illustrates, the current lack of interoperability among many providers’ systems makes sharing vital information beyond and even within their organizations an expensive, time-consuming, and error-prone task. There are both financial costs and potential clinical consequences. How much time does it take to send and receive a fax, on both sides? What do you suppose is the error rate when individuals have to read lab values from a fax and manually enter them into a record?

VBP participants are well aware of the shortcomings of faxing and the need to access claims and clinical data from across separate HIT systems. For example, in a poll conducted earlier this year, ACOs put two kinds of interoperability at the absolute top of the list of challenges they face. Some 78 percent of respondents cited “access to data outside my organization/network” as a key issue. The second-most frequently cited issue, mentioned by 62 percent of the responders, was “data integration” – that is, data sharing across the care continuum within the ACO’s physician, hospital, and ancillary components.

So why can’t most our healthcare information systems talk to each other? And what is being done about it?

The “why” is simple: All things being equal, it’s a competitive advantage for a vendor to keep its IT platform proprietary. And until very recently, there simply hasn’t been enough market or regulatory pressure on health IT vendors to tip the balance toward making their systems interoperable. Unless they were at-risk participants in capitation contracts, physicians and hospitals didn’t care about interoperability because they weren’t in any way accountable for what other providers did. Patients weren’t demanding access to their clinical information. And beginning with the HITECH Act in 2009, the emphasis at the Office of the National Coordinator for Health Information Technology (ONC) and at the Centers for Medicare & Medicaid Services (CMS) was almost exclusively on achieving medical record automation as quickly and broadly as possible. For that reason, HHS chose not to include interoperability requirements in its EHR certification standards. That policy choice meant that under the Medicare and Medicaid EHR incentive programs, providers like my two physicians spent a total of $28 billion of taxpayer money on systems that didn’t have to be able to talk to each other directly.

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Last modified on Monday, 23 November 2015 20:30

Philip Nathanson is the President of Nathanson Consulting LLC.  Phil has held quality leadership positions at CMS, Aetna, and NCQA. His consulting clients include hospital systems, HIM firms and biotech companies. His articles on quality and healthcare management have appeared in Becker’s Hospital Review, H&HN Online, Topics in Healthcare Financing and other journals.