How Will EHRs Help Shape Healthcare Reform?
Never since the creation of Medicare and Medicaid in the 1960s, or perhaps the first run at Managed Care in the 1970s and 1980s, has health care been poised to undergo the kind of dramatic change that we are seeing now. With various efforts underway to shift reimbursement away from the tradition of fee-for-service and more toward a performance (quality)-based approach – ACOs, Patient Centered Medical Homes, other Pay-For-Performance among private payers – there is increasing reliance on a technology backbone that will facilitate all of this.
Part of the picture has been concern about the frightening attrition seen in primary care physician (PCP) ranks, which stems from the payment methodologies in place in the U.S. – “you get what you pay for.” Moving toward different ways of compensating primary care in the U.S. that reward the social value provided here is an active debate occurring in policy circles.
The evolution of EHRs
The technology backbone of health care has also evolved, from mainly a billing/business set of tools oriented around medical claims to one that intends to replace the clinical recordkeeping in a medical practice with an electronic record. But, beyond simply replacing paper charts with their electronic equivalents, EHRs are moving toward a platform that will help transform the delivery of health care that is currently underway.
What does that mean? Beyond simply documenting doctor-patient interactions, modern EHRs have embedded the collection and display of Clinical Quality Measures (CQM), and along with that, clinical decision support to help achieve those Quality Measures. Payment methodologies in the future will increasingly rely on such CQM data to determine where the money should go – building a “business model for quality” is predicated on a technology platform that can reliable generate such information.
Also, the big mandate for health IT in the coming year(s) is the ability to share clinical data between places where it is needed. Health care is not generally practiced in a single location – on average, patients recall seeing around 18.7 physicians in their lifetimes, which means that a patient’s health story is fragmented across many different locations. In order for coordinated care to be effective – whether in a formal setting, such as a PCMH, an ACO, or a medical group or IPA charged with managing the care of a population, or in an informal traditional network of clinicians in proximity to each other – getting clinical information back and forth between clinicians needs to be better than it has been in the past. Referred-to consultants want relevant background information on patients they receive from referrals, and referring physicians want feedback from their consultants with clear recommendations. This “closing the loop” of clinical information sharing among physicians taking care of a patient is the foundation of health information exchange.
Another healthcare priority (one of the 5 national priorities that went into determining the criteria for the Meaningful Use program) is improving patient engagement in their care. EHRs must move from their doctor-centric legacy, mimicking paper-based recordkeeping of old, to one that not only collaborates with other clinicians (the health information exchange aspect of EHRs), but also involves patients in their own care.
There is a vast array of health data collected (“outside the walls of HIPAA”) by consumer-facing web sites already. Patients are not too interested in keeping their own health data in isolation (the failure of stand-alone PHRs such as Google Health illustrates this) – but self-disclosed health information that is shared socially has been an exploding space. Linking this kind of data (the “patients-like-me” stories) to protected, private Personal Health Records (PHRs) that are shared with their doctors is a new frontier of technology and social experience.
Medical device data, as well as self-reported consumer data, can be aggregated into patient PHRs (cradle-to-grave records), and thus can be shared with physicians (if desired). Conversely, physician summary data can be shared with patients via EHR-PHR connected products, which moves doctor-patient interactions away from the face-to-face-only tradition of healthcare towards one that is more online, community-based and in their “true” medical homes (where people live – not the doctors’ offices, even if such offices are called Patient Centered Medical Homes).
This shift in how health care is delivered, and what kinds of professionals deliver that care, is a trend we are at the first steps of taking. It requires payment reform to facilitate such novel methods of care (“you get what you pay for”). And it also requires a technology platform of the sort that we see emerging. EHRs are maturing out of being merely a doctor-office paper-record replacement, and are emerging as a community health data platform, which connects all the practitioners involved in patient care, as well as patients individually and collectively. This is an exciting time to be in health care. The technology landscape, as well as the healthcare landscape, are at a juncture never before seen.