System interoperability key to health IT innovation, payment reform

Without system interoperability, health care groups won't achieve information exchange or meaningful use, while payment reform will remain a pipe dream, some industry leaders say.

A lack of system interoperability limits IT innovation in the health care industry and stifles the payment reform many deem necessary to cutting health care costs in the United States, industry and government leaders said during a panel discussion at the 29th Annual J.P. Morgan Healthcare Conference.

The vast majority of health care software systems are administrative, noted Google Inc. CEO Eric Schmidt. Even the large providers with clinical and electronic health record, or EHR, applications "fundamentally have closed systems that are not interoperable," he said during the discussion, which was webcast live from San Francisco.

In offering a solution, Schmidt, a member of the President's Council of Advisors on Science and Technology, pointed to the recent PCAST report calling for the use of meta tag technology to take information out of proprietary applications so it can be exchanged more easily.

Such system interoperability is key to health information exchange, to the success of personal health record services such as Google Health and, fundamentally, to achieving meaningful use, Schmidt added. "The stakes here are huge."

For Todd Park, CTO of the Department of Health & Human Services, meaningful use is just the appetizer. The main dish, in his view, is payment reform. That also cannot happen without system interoperability being established first, because bringing hospitals, specialists and other providers together into an accountable care organization (ACO) cannot happen without what he called "information liberation."

Under the ACO model spelled out in the health care reform law, organizations would join forces voluntarily in a sort of primary care group, Park noted.

Ideally, an ACO could be compensated at a bundled case rate. For example, a single Medicare payment would go to the entire team helping a patient recover from a knee surgery, rather than an individual Medicare payment going to each team member.

Health care providers fundamentally have closed systems that are not interoperable.

Eric Schmidt, CEO, Google Inc.

This payment reform would address the largest flaw in the current health care system, in which "we actively disincentivize care coordination, since people are not paid for it," Park said. Moreover, improved health information system interoperability would promote care coordination, he added.

System interoperability cannot be achieved by maintaining the status quo, however. Aneesh Chopra, current CIO of the U.S. government, told the audience of investors about an experience in his former role as Virginia's secretary of technology.

In that state, cardiologists wanted to combine their patient data with information from local hospitals as a way of monitoring patient care. Large, incumbent software vendors told the cardiologists that such system interoperability was still several years in the making, while smaller, more nimble vendors showed a willingness to listen and address "where the puck is headed," Chopra said.

Software developers and their backers of all sizes need to visit health care organizations, "take a whiteboard, listen to their needs -- and listen agilely," Chopra said. Given the approaching deadlines for demonstrating meaningful use as well as improved care quality, he added. "The pace suggests that there's an opportunity."

Let us know what you think about the story; email Brian Eastwood, Site Editor.

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