Posted in Perspective

Integrated care needs comprehensive exchange

Charlotte Hovet, MD
Charlotte Hovet, MD,
Integrated care needs comprehensive exchange

The new payment models in the healthcare marketplace all provide incentives for coordinated care as a means of improving outcomes and lowering costs, especially for chronic diseases. As a consequence, 2014 looks to be the year of the health information exchange.
These new payment models will act as a catalyst for data integration across the industry. Without complete data, physicians, hospitals and health plans are at a significant disadvantage. While many health systems and physicians have adopted use of HIEs to exchange patient records, the information flow for most providers is neither easy nor smooth. The problem is particularly acute for health systems whose providers use a wide range of electronic medical record (EMR) software and for health plans (whose networks include providers using pretty much every EMR solution available).
This lack of interoperability is a huge drag on the healthcare system. Ideally, this change in the financial incentives will spark a new interest in interoperability between the EMR vendors. The current Tower of Babel environment, where there is no common language for direct interaction between clinical applications, does not serve the interests of patients, providers or payers. HIEs can be the Rosetta Stone that allows digital information to flow more freely.
The changing financial incentives might even spur a change in the basic orientation of EMR software. Historically, EMRs have existed to document clinical encounters and to secure billing for services rendered. But in this new environment, where healthcare providers and payers have financial incentives to keep patients healthy, EMRs should be more concerned with tracking patient progress and current and future needs rather than merely documenting individual encounters. Under capitation systems, which are making a comeback, providers won’t need to bill for treatments; instead, they will be paid to prevent the need for those treatments, and they will need an EMR that helps them see a unified view of a patient’s history and predict what services the patient will need to maintain the best health.
Until EMR software becomes interoperable and patient-focused, a powerful integration engine and an HIE capable of creating a unified patient record can bridge the gap and help healthcare organizations deliver better outcomes at lower cost. Ideally, every provider and every payer will be capable of exchanging data through an HIE. That includes physicians, hospitals, labs, pharmacies and any other organization that provides or pays for healthcare services.
A dedicated, secure healthcare cloud can help in this process, especially if it is structured to present vendor-neutral records and diagnostic images and can be accessed over the Internet. The easier it is for healthcare providers to access the data, the more likely it is that the data will be used when it is needed.