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Recounting a visit to a healthcare provider, ONC chief Farzad Mostashari, MD, proclaimed exactly why accountable care and health information exchange will succeed whereas the previous attempt, the managed care provider model, did not widely thrive.
Mostashari was speaking at a Bipartisan Policy Center event, Accelerating electronic health information sharing to improve quality and reduce costs in healthcare, at the Newseum in Washington, D.C. on Wednesday.
The provider, who Mostashari did not mention by name, broke out a triptych of reasons for optimism:
1. Quality matters. ACOs and HIE are not just about cost, providers must meet quality metrics.
2. There are open networks. Providers cannot “UM” patients, as in utilization management, because people now really can go wherever they want for care.
3. Patient engagement. Because providers cannot limit where patients go by UM’img them, the provider told Mostashari that it has to be sticky, engage the patient, make consumers want to come to them, if not actually delight patients.
“We never heard that before,” Mostashari said, adding that when a patient walks into a doctor’s waiting room, “the implicit message is ‘You’re really lucky to be here. Take a seat.’ Instead of ‘We’re really glad to have you here.’”
Mostashari, in his role as head of The Office of the National Coordinator for Health IT, of course, has helped to drive the meaningful use program that is headed toward those same three goals of quality data, health information exchange and interoperability and, ultimately, patient engagement, among others.
“One thing we have going for us that we didn’t have 20 years ago is data, being able to mange information in ways we simply could not do,” Mostashari added. “That’s the game-changer, that’s why we should believe the future of medicine is the brightest days of medicine.”
Whereas Stage 1 of meaningful use focused on collecting and structuring health data, the segue into Stage 2, is where data is exchanged toward the goal of population health management.
On top of that data are the government-driven and industry standards for moving it around effectively and securely. “The importance of common standards can’t be overstated,” said Karen Ignagni, CEO of America’s Health Insurance Plans during a session immediately prior to Mostashari’s address.
“From the standpoint of EHR vendors there needs to be much more focus on performance measurements” Ignagni said, because “we need to be rowing the boat in the same direction.”
Mostashari explained that during Stage 2 of meaningful use, “you’re going to see a major difference in your vendors not having to negotiate with each other,” over things like what coding system to use, how to package patient information, what secure protocols to use for exchanging data over the Internet.
And there are gaps in that vendor-to-vendor EHR interoperability and exchange today, as Mark Barner, CIO of Ascension Health pointed out during the same panel discussion in which Ignagni participated. Telling of a recent diagnosis that required him to see a primary care doctor, who referred him to a specialist who, in turn, ordered some tests, Barner encountered three different physicians who did not share data, practiced no interoperability, but used a lot paper.
“Living as a consumer,” encountering some of these interoperability and data exchange shortcomings, Barner said, “I look forward to when we can electronically share information.”
Robert Musslewhite, CEO of The Advisory Board Company said in the same session that this dialogue about accountable care organizations, EHRs, health information exchange is critical.
“If you can create interoperable flow of data in the health system,” Musslewhite explained, “clinicians can make better decisions, data-driven healthcare decisions, create insight out of the data.”
Mostashari explained that having data for decision making, and the simple act of a clinician looking at data on their collective of patients, not just individuals, is the foundation of population health management and “the fundamental difference between paper charts and electronic health records.”
Evoking Harry Potter, he said in a muggle world doctors simply cannot walk into a room of paper charts, wave a wand, and get answers about all their patients that can then be applied back to individuals.
Indeed, the digitization of the health system enables those three causes of optimism, quality structured data, exchange, and patient engagement – not that any of them will come easily or immediately.
“We’re impatient, there’s urgency, and all three of these have to change together.” Mostashari said. “And the crazy thing is that it’s happening, not just in the federal government, but in the private sector, in startups in California, and in the smartphone in your pocket.”