Those of us who worry about the government creeping into all our lives can now stop fussing and fighting, cry it all out, and move on to implementing the Affordable Care Act (ACA).
But first, we need two core competencies: the ability to integrate health information across providers AND (soon thereafter) the ability to separate signal from noise.
Both of these competencies will require a propagation of the cloud. Let me explain why.
Our work in the health care (EHR) marketplace remains the same as if the ACA had been reversed…and it’s the same work we SHOULD have done years ago. That is, to treat the information that gets generated during the provision of care as if the consumer was actually paying for it. Because, in fact, they ARE paying for it and always have been—but the disintermediation by both third-party payers and the government has allowed us, as providers of health care services, to get pretty sloppy with the information that gets created in the name of taking care of our clients.
While they are becoming more empowered, consumers haven’t throttled us during those instances when they must submit to a second test because the first result got fumbled somewhere in the care chain. Now, as each state goes for the federal dollars provided to them in the Affordable Care Act (ACA), they’ll feel greater pressure to…well…not lose information, and be able to provide it to any appropriate care giver who needs it. All while still trying to balance their budgets.
We are already seeing numerous efforts around the country to improve electronic tracking of health information, but, in most cases, the track-keeping is contained within a given health care provider’s environment. This makes it harder for people to shop around for the best provider at the best price.
Tuning the “Signal-to-Noise Ratio”
Cloud-based services automatically move patient information between providers, regardless of their “tax ID number”; yet hospitals that don’t use such services will need to invest not just in systems, but also in the ability to exchange information. This will not go well. Most health care providers don’t have this kind of technical competence…but they also don’t really have an incentive to make this happen…which is kind of why we haven’t done this yet as a sector.
When we do, providers will be held to an unprecedented level of transparency. Not only will they need to be able to share and access information from all the care a patient has received but, as long-time keepers of EHRs are learning, they’ll need the ability to sift through it. As health care integrates, we will need to fine-tune the “signal to noise ratio” in electronic charts. Pushing around all the info ever collected on a patient, in one great electronic dump, would be a disaster. Hopefully, this law will yield some improved filtering.
Different Data for Different Audiences
Again, cloud-based services that can filter and constantly re-filter patient information based on the person viewing the information, and the reason for viewing it, will be massively important in preventing information overload. Are you a doctor looking for an inconsistency in lab results? Are you a patient-centered medical home (PCMH) coordinator looking to ensure compliance? The ability to show data in different ways for different audiences is probably the single most essential non-existent competency in health information management today.
If we get these two competencies in place, and we squint a little, we can have some idea of the efficient, innovative marketplace that health care could be without the third-party system. For our part, we at athenahealth are running flat out to build these competencies for our clients…and ourselves. Anyone who doesn’t should simply be called “offline.”
(Also, please see my op-ed in The Huffington Post that was published just before the ACA ruling.)
Older physicians are less likely to use an EHR system than their younger counterparts. A recent Health Affairs study found that in 2011 30.8% of physicians older than age 55 were using a basic EHR system, compared with 40% of doctors younger than age 40 and 35.5% of doctors ages 40 to 55.
Located in Huntersville, N.C., the Rosedale Infectious Diseases medical practice tries to provide a welcoming patient environment for its roughly 2,000, mostly HIV-positive, patients. Given the consequences an HIV diagnosis can have on future care, Rosedale also provides an on-site laboratory, a food pantry and a pharmacy.