Making Data and Accountability the Routine By-Product of the Use of Health IT
Health IT can help make all health care professionals and organizations - physicians, hospitals, other providers, health plans, drug firms, device firms - more accountable stewards for quality, safety and cost results, and for the engineering required for continuous improvement. We can learn from our current supply, care delivery and finance processes in the same ways that Toyota and Wal-Mart monitor their internal business processes.
But we need to design data aggregation into the products from the start, not as an afterthought. The problem is not just that we lack some important data elements to carry out these analyses now. More to the point, we have not committed nationally to aggregating, analyzing, and reporting the massive amounts of health data that we already have. Similarly, due to a lack of incentives and competing interests, most professional and organizational health care players have resisted using data to improve the quality, safety and cost of American care.
Interoperabilitiy of various EHRs is absolutely critical to the ability to cost-effectively collect, manage, and report outcomes data. All health IT products used in the care of diabetic patients, for example, ought to be required to export performance data relevant to care of diabetes in standardized formats. All research of any kind depends on this capability.
Removing the Complexity and Cost Associated with Multi-Payer Claims Administration
Health IT ought to make claims payment, eligibility look-up, co-pay verification, and other administrative processes simpler, easier, and faster for providers, patients, and family members. There is no good reason why we don't currently have an all-payer clearinghouse for patient administrative and financial information that is standards- and web-based. There also is no good reason why, in the era of PayPal, physicians and hospitals experience Days in Accounts Receivable of 36 and 55, respectively. As Rick Peters has written recently, it is time for us to build a scalable, XML, and cloud-based claims adjudication, public health, and quality reporting system to replace the entire archaic mainframe systems at CMS and their fiscal intermediaries. "Make the winning solution open source, implement it for Medicare and the CDC, and offer it free to every state Medicaid program and all the commercial payers," he says, and we agree it is time to use updated technology to resolve the inexcusable claims administration mess.
Closing the Collaboration Gap
Finally, a new generation of health IT platforms and services will close the "collaboration gap" that exists between the system's many sequestered players, who as a result perform so much less effectively and efficiently than they otherwise might. Clinicians, for example, diagnose disease and set up treatment plans but often are isolated from helping patients cope, manage, or adhere to these plans. Patients, once diagnosed, are motivated to manage their illnesses but often have few tools or methods to assist them. Purchasers and payers want to see clinicians use the most efficacious resources, but typically do not have a way to inform and reward evidence-based purchasing processes. In every case, health IT can facilitate a more collaborative experience that is tailored to the user's purpose, no matter what role that user plays in vast health care space.
Health IT presents enormous, unprecedented opportunities to improve the quality of care, to dramatically reduce the waste and cost inherent in our current approach, and to culturally transform physicians and patients so both become more actively engaged in improving health and health care. Bringing the fluidity of health information and knowledge that is just starting to fruition will allow us to leverage the true power of information engineering, and that can take many forms. We think the name "clinical groupware" is more appropriate to this new class of health IT products and services than is the term "EHRs." In any case, the real health IT challenge to the Obama health care team is to step back, take stock of the kinds of applications that are emerging in the domain of health IT, including EHRs, and create an expansive, open policy structure that can leap beyond the status quo and really change the way American health care, in all its facets, works.
