Health IT orthodoxy after the Supreme Court
Instead, the orthodoxy says we should focus on clinical outcomes and the technology should simply conform. Increased strategic specification of core transactions could be accomplished through the current certification structure.
Or why not change the orthodoxy that has the country only funding increasingly complex EHRs? Alternatively, we could orient the funding more to the digital data themselves. The latter could establish an ecosystem around high-quality, standardized data in exchangeable summary records, problem lists and care plans, etc. with whatever software was needed to get to them.
[See also: 4 predictions for the future after the SCOTUS ACA ruling.]
Small industries might also develop to record and manage digital data for providers. But, at minimum, there would be comparable, accessible digital data for continuity of care and population needs like comparative effectiveness and accountable care. In some emergency departments, a component of an approach like this exists with scribes who take the electronic data entry chores out of the providers’ hands. Not everyone could or should have scribes, but this approach is more fundamentally challenged by the orthodoxy that requires providers to be the ones recording the data so that they can then receive alerts and reminders from clinical decision support.
Now this is an Alert!
And this is exactly where the last orthodoxy crack we will mention resides. It seems that clinical decision support is not really changing outcomes right now. A recent article in the Annals of Internal Medicine, by Tiffani Bright, David Lobach and others reviews 148 clinical decision support trials. While it finds that clinical decision support is "effective at improving healthcare process measures across diverse settings" it also finds that "evidence for clinical, economic, workload, and efficiency outcomes remains sparse".
So, unwinding this, if clinical decision support will, at least, take a while to have productive outcomes perhaps we can tolerate providers getting help inputting and managing good quality digital data now. And if we can focus on the data more, perhaps we can focus on the EHR software less. And if we focus less on the EHRs perhaps we can focus more on broader health IT systems and population health outcomes that are the more fundamental connection with health reform.
A new orthodoxy
The collective breath holding for the Supreme Court ruling on ACA can now be exhaled. But it is an opportune time to examine the current HIT orthodoxy and see if it needs refinement moving forward. There are lessons from the immediately visible cracks that need to be considered.
[Q&A: We now have a framework for health reform.]
First, we need to expect outcomes from health IT to be more long than short-term and we should anticipate that we will need to have a robust infrastructure to fully get there. Second, since many of the needs for, and benefits of, health IT seem to relate more to population than to individual patient care outcomes, the orthodoxy should prioritize population health IT to a greater extent than the focus on EHRs alone will allow. And third, the orthodoxy should focus more on good quality data and less on software. This focus may not be comfortable for those who fear talking about data aggregation and trusted data users, but it will be a more resilient direction that is less likely to get hung up in specific software issues.
It looks like the Affordable Care Act may here to stay for a while – and now we probably need to consider a HIT orthodoxy 2.0 to better support health reform goals.
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