WALTHAM, Mass. -- Health data interoperability might seem a years-long, seemingly never-ending quest for national figures like the ONC's interoperability czar Doug Fridsma, M.D. But for Massachusetts health care providers, it needed to be done yesterday. Or, more precisely, 2016, because that's when Chapter 224, also known as the Health Care Cost Containment law that went into effect Nov. 5, mandates it will happen.
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Interoperability will be the key to accountable care organizations (ACOs) -- also mandatory under Chapter 224 -- gathering the population management data they will need not only to get paid, but to manage the care of patients and find economies to stay within payment capitation constraints.
State representative and lead author of the bill Steve Walsh (D-Lynn) recently joined other state officials and health care providers at a panel sponsored by Arcadia Solutions to discuss the role of health IT systems in fulfilling the law's mandates.
Walsh, who also chairs the Massachusetts House Healthcare Finance Committee, told attendees that his experience managing the care for his infant son's heart problems in 2011 and the ensuing "96 days of the next year in the hospital, sleeping on a window sill," informed some of the health IT provisions in the bill. He told SearchHealthIT afterward how he learned firsthand about the lack of interoperability between health care providers.
"It was frustrating; it was all about self-preservation, and not about preservation of the system," Walsh said of hospitals caring for his son, whose health data did not easily move between providers. "This isn't about one or two hospitals succeeding. For the industry to succeed they need to figure out how to work together and complement each other -- and that has not been happening. They all have been living in their own little silo, and IT can help to break down that barrier so people can talk to each other."
Chapter 224: Just do interoperability -- your way
Walsh added that the Massachusetts legislature could have taken a more prescriptive approach to health IT interoperability, but instead elected to mandate it in general terms and let the market find its own path to compliance. Chapter 224 earmarks about $30 million in state funding to help build health system data interoperability, so cost cannot be used as "an excuse" by providers for their not becoming interoperable when it comes to exchanging patient data. "They have to get there," he said.
Steve WalshMassachusetts state representative
In addition to funding health IT initiatives, the law creates a number of boards and commissions, including the Health Policy Commission. That 11-person board will oversee the benchmarking of health care costs for the state. The group will also administer a key part of Chapter 224, tracking what individual providers are charging for care -- and determining which ones must take corrective actions, called "performance improvement plans," to reduce their charges or risk stiff fines.
Jay Gonzalez, secretary of the Massachusetts Executive Office for Administration and Finance, said while the law might have some lofty goals, his office and others in the administration will attempt to keep the process of achieving them "deliberate and thoughtful."
"We need to do something to try to contain growth in health care costs," Gonzalez said. "This legislation, no doubt, is imperfect. We think there's a lot to like about it, there are lots of different strategies embedded in it ... we're committed to doing everything we can to implement them in a deliberate, effective way."
Health data interoperability for ACOs an expensive task
Just tracking costs is no simple proposition, let alone fixing the problem of stemming the growth of health care costs, which have increased to the tune of $1 billion per year since 1990 for Massachusetts. Steward Health Care, a Boston-based health system and one of the original 32 CMS Pioneer ACOs, is "aggressively" investing somewhere between $200 million and $500 million into health IT systems. The goal is to make its patient data analytics systems robust enough to handle the heavy lifting of population health management for the new payment models, said Ralph de la Torre, M.D., Steward chairman and CEO, during the panel. A chunk of that investment will pay for making systems within Steward interoperable.
Illustrating the complexity of the interoperability issue just within Steward -- let alone interfacing with external health care entities -- de la Torre explained some of the projects his company is working on. Interoperability among systems from Meditech, eClinicalWorks and Athenahealth Inc. connected to Steward's network takes multiple copies of multiple data repositories. Hooking up all the various systems -- especially to primary care physicians' offices at the very ends of their network -- takes a lot of unifying code, constantly updating a master patient index and "a lot of HIPAA paperwork."
It's not much simpler to connect data between hospitals, which are all on the same Meditech 6.0 system that cost "a bazillion dollars," as de la Torre put it.
"Every one of our hospitals has a different dictionary," de la Torre said, "so they all have different codes for different procedures within the Meditech system, and we're now having to rewrite [all of them] in order to unify all that."
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