In Health - HIT

The healthcare system in the U.S. is riddled with problems, not the least of which is our consistently poor rankings in health indicators relative to other developed countries.  Apparently, the old saying “you get what you pay for” does not apply to $2.7 trillion healthcare systems.

As a result, patients, payers, providers and systems have all been aggressively searching for ways to “bend the curve” on healthcare costs while simultaneously improving quality of care.  One of the more agreed upon solutions is not the least bit novel or innovative, but rather is something patients have wanted and providers have aspired to offer for many years – coordinated care.

Few would argue that improved information exchange and care coordination have the potential to improve care quality while drastically reducing costs by ensuring such simple outcomes as reducing unnecessary and duplicative testing and preventing medication errors.  Estimates assert that a lack of coordinated care accounts for $25 to $50 billion of annual waste in our healthcare system.

The potential savings and quality improvements are significant enough that some have proposed care providers should be reimbursed for performing care coordination activities.   With billions of dollars in incentives being generously paid out by CMS every year in the form of Meaningful Use and PQRS reporting, neither of which directly involve patient care, why not incentivize care coordination?  As it turns out, the folks at CMS feel the same way, recently announcing a proposal to offer coordination of care payments to primary care physicians beginning in 2015.

So we have now recognized the problem and incentivized the solution, but we are still missing one key piece – the tools to make that solution a reality.  Enter health IT.  Even the most anti-technology care providers I have come across have acknowledged the potential value health IT brings to the care coordination table.  Whether it be in the form of health information exchange, tracking transitions of care, or real-time secure online communication, health IT promises to play a central role in the transformation from the traditional fragmented, episodic care of today to the seamlessly coordinated, longitudinal patient-centered care we aspire to provide.

It’s not surprising, then, that health IT and its transformative potential have generated a great deal of excitement among both clinical and non-clinical stakeholders.  Unfortunately, preliminary studies looking at the impact of EMRs and other health IT products have largely failed to produce consistently positive results in the form the improved outcomes and costs.  This begs the question:  if everyone agrees we need to improve care coordination, and everyone agrees health IT will be a key in making that happen, then why are we failing to see results?

Certainly it will take some time for providers and systems to gain increased comfort with using newer technologies and to begin incorporating them into their clinical workflow.  However, there seems to be a much more prominent barrier to the seamless coordination of patient care – the utter lack of coordination between health IT systems.

At the end of the day, care coordination is about communication.  While CCDs and data standards are great first steps towards improved information exchange, they do not exactly represent the holy grail of care coordination.  The communication needed for clinically meaningful care coordination must be dynamic, real-time and relevant.

Unfortunately, the technology currently being used in healthcare is largely outdated and fragmented.  As a result, we continue to deal with early generation EMRs and health IT products that lack routine functionality considered standard by IT developers in other industries.  Now couple this with the time and financial pressures placed on health IT developers to meet Meaningful Use requirements by the Affordable Care Act.  And where does that leave us – with a healthcare system built on a foundation of technologies that lack interoperability, lack the design and usability to fit within existing clinical workflow, and lack the functionality to meaningfully coordinate care.

As tempting as it might be, debating who is to blame for the current shortcomings of health IT in the U.S. is both futile and unproductive.  The reality is this:  it is unrealistic to expect seamless coordination of patient care until we better coordinate the health IT used to provide it.  And it will require everyone working together to make that happen.



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