With the ONC’s recent release of their 10-year interoperability vision, it might seem like the industry is starting to make things easier for clinicians. In reality, 2015 is starting off to be one of the worst times ever to be a physician. Interoperability is a critical issue to support a transition from fee-for-service to value-based care. Physicians will eventually be reimbursed around their ability to impact clinical outcomes, so the need for clinically relevant information at their fingertips is mission critical.
Unfortunately, the ONC’s attempts at outlining an interoperable future make it clear that this vision is influenced by the same vendors that benefited from billions of dollars flowing to them from great federal programs like ONC’s Meaningful Use and will continue to benefit from a roadmap that delays the path to data and streamlined clinical workflows. Preventing caregivers from being overwhelmed by data is understandable, but it is certain that physicians need more data than the ONC is seeking. How can physicians be efficient and effective if they don’t get the information they so desperately need? How can we move them into a value-based care model without freeing the data needed to improve clinical outcomes? My colleague, AirStrip President Matt Patterson M.D., recently wrote a blog post around this, emphasizing how low the bar has been set in terms of standards.
The directive generating the most attention calls for “a common set of electronic clinical information…at the nationwide level by the end of 2017.” According to ONC, the common data set would consist of about 25 basic elements, such as patient demographics, immunization records and lab test results. It seems this vision was created to help ease the strains physicians face with the overwhelming amounts of data. However, the basic elements ONC is suggesting is a subset of the relevant data that is trapped in the source systems; it is not nearly enough information for physicians to make informed decisions effectively.
These limited requirements are also preventing the enforcement of standards and the creation of new ones that would encourage the healthcare industry to partner with vendors to improve the inner workings of their health systems. In order to understand clinically relevant data in near-real time, hospitals need about five to six times the amount of data ONC is proposing as a common data set for the initial phases. This additional contextual data is crucial in order to decide next steps and make patient decisions proactively and effectively. Some vendors today have the ability to expose this data but, for some reason, healthcare providers continue their acquisitions without strong interoperability requirements – as if they are obeying ONC’s roadmap and those that influenced it. In an era of consolidation and collaboration, this approach will lead to patient leakage for closed organizations.
The blocking of clinically relevant data from some legacy vendors and ONC’s relaxed requirements also stifle innovation, impeding new vendors that provide data analytics and visualization tools that are agnostic to the data source and result in a better user experience. This impediment forces providers to use their archaic visualization tools. This trend started with desktops and is quickly propagating to mobile devices. We are, in essence, mobilizing the mess and making physician’s lives more difficult. Not only are we limiting their access to data on a real-time basis, but we are now forcing them to open multiple mobile applications to view a patient record throughout the continuum of care. And to top it off, we will force them to improve population health management and care coordination, while aligning incentives around those goals.
Healthcare cannot mobilize or leverage innovations such as telemedicine without first being interoperable. Interoperability is the core of successful mobile healthcare, we cannot place all the blame on the ONC’s interoperability roadmap. It is time for healthcare providers, payers, pharma and technology vendors to join forces with the Federal Government and transform healthcare. As we gear up for another HIMSS, it appears interoperability will once again be a topic of discussion for the future. Maybe next year, it’ll finally be accepted as a standard and the topic will be centered around the patient who in the end should own their data.