November 29, 2018
Technology in service of improved outcomes, not the other way around
By: Dr. Ron Moody

Health care costs continue to rise. Despite a massive push to increase EHR use. Despite workflow disruptions and increased physician burnout. Despite all the talk about data analytics and interoperability.

It’s likely that less than 25 percent of health information in modern EHRs is stored in a form available for ready use to support better health outcomes for an individual patient, or a population. An even lower percentage is available as part of longitudinal 360-degree view of a patient’s health data as recorded in the EHR. Data in other EHRs, claims data, and data available on the patient life/health outside medical care is typically missing.

Most of the information is not computable, or often even findable. Healthcare organizations need tools going forward that both identify and capture data, and to harvest and verify information often found in the narrative sections of historic notes. We need resources to make data actionable at the point of healthcare delivery, for the support of the patient, and for population health. Which means that government policy should shift emphasis from technology to outcomes that technology can enable.

It’s often said there are not enough physicians involved in building EHRs. This is likely not the case. Transformative change needed in the EHR and healthcare will not come from just the physician perspective. Physicians alone are not the best source to define future use cases or the tools needed for current as well as new models of care. Health and healthcare has never just been about the physician. It involves the activities of a team best designed to deliver the Quadruple Aim and to assume new roles. Health is primarily controlled by the patient.

The physician and entire clinic team must insist on technology that performs better, is designed around improved care processes, supports better usability to include minimal clicking, and minimally disrupts conversation and cognition. Outcomes, not the technology or current processes, should drive change.

As the movement to focus on accountable and value-based principles grows, there will be greater emphasis on outcomes and measures. Focused on the Quadruple Aim, it is imperative to not only allow patients access to their data from any EHR, but to make them an equal partner on their care team. The patient controls decisions that impact a larger portion of healthcare costs, and in many cases control the health outcome.

You can measure if the physician ordered the AIC and reminded the diabetic patient to get the test. The patient is responsible for getting the test, taking the medication, exercising, and monitoring their diet to lower the AIC. Patient have to be truly empowered by actionable engagement in the process. This will allow Health IT systems to move from reactive medical care, compliance, and billing systems to proactive, innovative solutions based on different models of care.

Creating fundamental change in the way we deliver care to support healthier lives requires a fundamental change in our thinking. Technology is not the solution, nor is technical interoperability. The solution will come from focusing on achieving outcomes in a truly patient-centric construct, which entails enhancing service delivery. Technology can be a wonderful enabler, if it enables desired outcomes and new processes.

Sticking to known processes and incremental optimization will result in healthcare organizations having a Kodak moment, becoming obsolete as digital-enabled processes are used by others.

Here are some recommended actions to ensure that doesn’t happen:

  • Government CMS focus on outcomes achievement, not interoperability in isolation. Link payment upgrades to technical changes that support outcomes.

  • Healthcare providers should demand IT changes that support improved outcomes/evidence-based healthcare delivery. Demand changes that align with future healthcare and health support needs.

  • HIT focus should be not only on standards for moving data between systems, but making the data usable and actionable after it has been moved -- part of a true “longitudinal record of health.”

  • Patients should demand a greater role in their healthcare engagement and access to the healthcare team.

Let me know what you think, as we continue to move through our exploration of IT and how it can be used to better healthcare outcomes.

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