Health data sharing needs an overhaul
■ To create a truly interoperable health care network, physicians need the incentives and flexibility to receive, use and share information.
Posted May 13, 2013.
The backbone of the efficient and high-quality health system everyone seeks is data. It's not only about the patient information that resides within an individual doctor's electronic health record system — it's also about the physician's ability to share that data with others, and receive data in return, to coordinate care and give doctors the most complete picture possible.
Unfortunately, that backbone is lacking strength. For many physicians, policy, payment and technology issues have rendered data exchange a distant dream instead of a daily part of practice life. For doctors and the health system to get the clinical and financial benefits that EHRs can bring, connectivity has to happen. Physicians are trying to overcome these barriers, but they can't solve the issues on their own.
Recognizing there is a problem, the Dept. of Health and Human Services Office of the National Coordinator for Health Information Technology, which coordinates use of health technologies, sought comments on how the federal government could help make the system work better. As of the end of April, the American Medical Association and more than 200 other organized medicine groups have responded.
In its letter from Executive Vice President and CEO James L. Madara, MD, the AMA stated its support for advancing electronic health information exchange and operability to further the goal of a high-performing health care system. The Association sees that as critical to improving the Medicare fee-for-service payment system and fulfilling the potential of physician-led payment and delivery systems such as accountable care organizations and patient-centered medical homes. But the problems preventing that from happening, as the AMA and other medical organizations laid out, are myriad and complex. They can't be solved by just one agency or group of stakeholders.
Among the issues:
- A lack of financial incentive for communication. For example, Medicare does not pay for email consultations, consults with other physicians or support for patient self-management. If the Centers for Medicare & Medicaid Services provided such payments, it would provide “an enormous incentive,” Dr. Madara wrote, for doctors to spend more on care coordination and to redesign their delivery care to support it.
- A one-size-fits-all meaningful use EHR incentive program. It forces physicians to use older technology. In some specialties, doctors are required to spend time inefficiently performing and recording tasks that are not a regular part of what they do. Long-term-care facilities and home health professionals are left out of the program entirely, inhibiting communication. Already, 73% of physicians and eligible professionals have registered for meaningful use incentives, according to the Centers for Medicare & Medicaid Services. But the program's problems mean there is no guarantee that these doctors are connecting with who they want and when they want. Allowing doctors to find products at a good price that fit their needs, rather than merely choosing from a required list, could help them get more out of their technology, including connectivity.
- An unstable health information exchange business model. HIEs are entities that allow doctors, hospitals and others in their coverage area — whether that be state, regional or local — to exchange data easily with each other. HIEs can hook up with each other, thus creating a national network. The problem is that many HIEs are having trouble creating a sustainable financial model, and some have shut down. Others rely solely on federal grant money that soon will run out. Many physicians are among those paying to be a part of HIEs, but other doctors are opting out because costs are too high. The expense is a concern, especially for something that's not expected to give doctors any financial return. Physicians also are reluctant to sink money into unstable HIEs. The AMA letter said the HIE situation could be improved by payment and meaningful use changes that would give doctors a greater incentive to participate.
There are many other issues of concern, including questions about exactly how patient data are tracked and who owns that information as it is passed to and from an HIE system. Also unresolved is how the government can push to ensure that standard forms are adopted so that doctors spend less time tracking insurance claims. Tying these issues together is the belief that physicians — rightly — should be held accountable for care provided to patients. What they can't be held accountable for, as the American Academy of Family Physicians put it in its own letter to ONC, are “actions or inactions of organizations beyond the physician's scope of control or even influence.”
Give physicians the flexibility and incentives to get the technology they need so they can spend the time coordinating care for patients. Without that, don't expect the system to have a backbone strong enough to carry the weight of the high expectations set for it.