In recent weeks, I’ve witnessed a huge change among my practicing colleagues. For the first time, the true cost of vendor-proprietary records is seen as an existential issue for practices that may need to join an Accountable Care Organization to survive.
To a doctor in the good old days, IT meant practice management as a tool to get paid. As the days of fee-for-service give way to ACOs and global payments, doctors are starting to realize the direct link between payment, health records and patient engagement.
In a recent essay titled “Show Me the Money” in Patient Safety and Quality Healthcare, Barry Chaiken, MD summarizes:
“Regular assessment of quality performance will identify those providers who might be withholding care or over-utilizing care, helping to balance the equation between clinical and financial objectives. Entities such as ACOs and patient-centered medical homes will either take on the financial risk and therefore share in the savings generated by their transformed care delivery processes or receive added payments, along the lines of current pay-for-performance schemes, for delivering predetermined clinical and financial outcomes.”
Doctors are now facing the reality that the EHR they rushed to buy for Meaningful Use might need to be changed if they join an ACO. Soon they will realize that patient engagement, long regarded as unpredictable and unfunded, is also linked directly to their income.
An ACO that avoids over-utilization by relying on a patient’s actions external to the ACO and considers her specific preference profits two ways: through shared savings, and through higher patient satisfaction scores. For the first time, health records are linked to patient engagement and meaningful collaboration.
The true cost of an EHR now includes the cost of interoperability and patient engagement. Health records vendors and state-sponsored Regional Extension Centers can no longer ignore this simple fact just because Meaningful Use Stage 1 did. There’s no time to lose as we consider Stage 2.
I hope Direct Project and Blue Button will be explicitly adopted in Stage 2. We also need both CCR import and export secured by patient-authorized OAuth links. These referral and second opinion tools are simple, Internet-tested, low-cost ways to shift costs outside the ACO. They can engage patients to help measure and report satisfaction while building respect for the ACO.
Doctors, now facing reduced payments and high IT costs, will demand practice portals that expose simple interfaces for patients to link external resources and to capture the satisfaction feedback essential to the success of health reform.
Adrian Gropper, MD is a founder of MedCommons and consulting on health services strategy at HealthURL.com. He is driven by the vision of doctors and patients collaborating around shared health records on the Web.