Are Patients and Interoperability Finally Coming to the Fore of Health IT?

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.

4 replies »

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  2. Dr. Gropper,

    I believe people are starting to wake up and realize that they cannot always depend on the health care system to diagnose their ailments and make a decision for them.

    I recently conducted an interview with author Thomas Goetz on his book “The Decision Tree: How to Make Better Choices and Take Control of Your Health.” It stresses that there is power in the lay public collecting their own health data so they can make conscious decisions in every aspect of their life style (e.g., health, diet, physical activity, sleep, etc).

    Do you think this level of involvement (patient decisions making) is a trend we will see increase over the next years? Especially with the younger generation as they are always using various technologies (e.g., Smartphone Apps, etc) to keep tab on other aspects of their lives.

  3. I agree with Ms. Gur-Alie on this one. Obamacare is not about patient satisfaction, but government control of physicians’ and patients’ behavior.

  4. Adrian, I wish I could share your optimism, but from all I read and see, I don’t think patients are any closer to the fore, or the center, than they’ve always been.

    Neither the Direct Project nor the Blue Button (which is a rather odd contraption) are mentioned in the Stage 2 proposal. Instead, there is an arbitrary requirement to connect to 1 HIE or 3 out of network providers. It doesn’t say why, or what should be exchanged – just 1 or 3.
    For the so called engagement, there is a proposal to have 20% of patients using the Portal. The only way I can think of that a physician can be sure to accomplish that is to make patients sign into the portal as part of the check-in process at the front office. Patients with no internet access are excluded, but how is the EHR supposed to know who has DSL at home? Should the doctor ask if you have internet at home? Another checkbox?
    This is completely ridiculous in mind…..

    As to ACOs, the “industry” is not at all interested in allowing patients to have a voice in this round of capitated arrangements any more than it did 20 years ago.
    See Paul Levy’s earlier brief post on this blog