This is Part 1 of a three-part series on The coming storm in healthcare.
There are real challenges with Electronic Medical Records (EMR) beyond getting doctors to write things down (a feat in itself). Healthcare providers are being pushed to adopt EMR, but few are at Stage 7, shown at right. Because certification at lower levels doesn’t mean system interoperability, EMR ends up a fenced-off island in a sea of medical information. EMR systems are being implemented as applications sitting on static data.
Imagine instead a world without information silos where healthcare Providers and Payers understand data in motion, meaning it can be interacted with to make sure it is helping the right people make the right decisions at the right time and most importantly, in the right context.
EMR and EHR
Discussions of electronic medical records commonly use two acronyms, EMR and EHR. The difference is part concept, part marketing: EMR refers to the electronic record of an individual that is created and stored for the purpose of treatment, while EHR is a collection of EMRs across multiple healthcare organizations. The goal is to make use of EHRs built from EMRs. These two together are the intended target of healthcare reform, but are we making meaningful progress? Not if we’re reliant on the latest patch/version of a particular EMR/EHR software.
Enter the Health Information Exchange (HIE). HIEs are intended to solve the issue of fragmented data across healthcare organizations by hosting data on a third-party platform. There is debate around whether this should be a centralized or federated model. Response? An HIE that doesn’t allow for the liberation of data merely creates another layer of fragmentation, centralized or not. HIEs serve their purpose as consolidators of data, but just like EMR and EHR, end up as silos of data that won’t improve the quality or cost of healthcare. The data needs to be available when it matters and not locked down in a database waiting to be queried.
Carrot and stick
How did we get here? It was pretty clear from the beginning that realizing EMR goals wouldn’t be easy, so the Federal Government created a carrot and stick approach. The carrot is cash payments to hospitals and clinics as they certify they’ve accomplished the previously mentioned levels of EMR. Hospitals have the carrot of their need to control costs and grow market share. For ambulatory care, economic stimulus funding was an early driver.
The stick for everyone (hospitals, clinics and ambulatory care) is that Medicaid and Medicare, the single biggest Payers, will reduce payments to facilities not meeting EMR timelines by 1% starting in 2015, 2% in 2016 and 3% in 2017. With most healthcare facilities operating at 2% margin, that won’t be a pain tolerated for long. But that doesn’t ensure we’ll get to the true nirvana of driving healthcare decision as events occur so that outcomes can be optimized.
Just as with systems to manage and move data (EMR, EHR and HIE), the trick is data interoperability and the carrots and sticks in place don’t address that in a meaningful way.
Each has a solution designed to capture electronic patient records. Does that mean they can connect to other solutions in place in healthcare facilities? Not necessarily. While healthcare organizations are chasing incentives, they’re not rewarded for integrating the wide array of systems that are part of patient-facing healthcare. By some estimates, for every one EMR system being certified, there are 100’s of others that aren’t bringing data together. This fragmentation won’t change by constantly rewriting silo’d software or simply connecting to exchanges. The solution is to see EMRs and HIEs as just one aspect of data capture and management while allowing for more nimble and event-driven platforms to manage data in motion.
EMR implementation rates are showing gradual rise with about half of all facilities reaching some level of adoption. But is it meaningful adoption? Several web sources report that “…only 20.4% of all physicians reported using a system described as minimally functional…” If this is true, EMR implementation isn’t driving the benefits hoped for. It would mean that the error reduction, reminders and alerts, clinical decision support and other benefits aren’t being fully realized.
This isn’t surprising when you consider that the systems being implemented capture and produce data but don’t act as event monitors, social media tools, and data integration points between systems. What needs to happen is for doctors and patients (yes, patients) to see data in motion. Only then can outcomes be driven more effectively by the system making contextual recommendations to the healthcare staff.
Mobile and Social EMR
Beyond silo’d data, limiting healthcare data to a work station would be a shame considering the wave of mobile and social technology that is coming to the workplace. Healthcare data needs to be available wherever needed and in the proper context. We have social platforms that are fast and easy to implement with security and are the most meaningful way to share protected data, and not just with between care professionals, but with the patient and their support community (family and friends they designate).
This is an answer to the some of the biggest challenges facing healthcare. Mobile and Social combined with ‘liberated’ data in motion provides access and convenience where we currently have little transparency and plenty of manual work.
Electronic records are only a first big step in healthcare transformation. Data needs to be mobile, social and event-enabled for healthcare transformation to take place.