Electronic health records may play a role in lowering costs and improving quality, but in order to unleash these benefits, some changes to the software and its implementation may be needed.
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"EHRs weren't designed to accumulate the kind of data we need for population health or bundled payments, so we've got some work to do there," Joseph Pleasant, CIO of Premier Inc., said in a session at the World Health Care Congress.
As you start to get value and start to try to implement patient-centered medical homes and ACOs ... the value is going to be in the connection of the verticals.
Enand Rizk, M.D.,
president, McKesson Health Solutions
He added that most of the initiatives currently underway to improve care quality and lower costs rely on some kind of accountable care model. These models may hold promise, but they need to be enabled by the right technology. Unfortunately, today's EHR systems are typically designed to document instances of care for doctors operating in fee-for-service payment schemes.
In order for the health system to improve, doctors need to have access to the kind of data that is most relevant to their patients' conditions, not just information on what the doctor was able to bill for. To achieve this, EHR systems will need to gather standardized data from many sources.
"It will get better with more standards," Pleasant said. "This will help get from basic analytics where we are today to surveillance analytics that automatically get data to the right person at the right time to make things actionable and proactive."
Panelist Emad Rizk, M.D., president of McKesson Health Solutions, said simply accumulating data is not enough. Today most health care providers leave clinical claims and other forms of data in silos, Rizk said. This prevents organizations from making meaningful connections between data points. As providers implement new technology they need to think about how these systems integrate with existing ones in order to break down these silos.
"That automation and that level of technology adoption is very vertical," Rizk said. "But as you start to get value and start to try to implement patient-centered medical homes and ACOs, the value is not going to be vertical. The value is going to be in the connection of the verticals."
He said most technology initiatives today try to automate or improve the efficiency of one piece of care delivery, but this piecemeal approach rarely delivers system-wide efficiencies that lead to meaningful improvements. Technology should be implemented to fill a specific role as part of a broader plan.
Available IT products don't exactly facilitate this kind of approach. Rizk said there are currently no EHR systems that can function as a reliable longitudinal medical record. Additionally, data is not portable. These factors make it difficult for providers to implement systems in truly connected ways, thereby hindering efforts to make care more accountable.
The industry may at least be heading in the right direction. Bryan Sivak, chief technology officer at the U.S. Department of Health and Human Services, said the first stage of meaningful use was mainly intended to spur EHR adoption. Subsequent stages will focus more on what doctors do with the data they collect. The first stage has largely been successful, Sivak said, as a large percentage of the nation's providers now have electronic record-keeping systems in place.
Once providers start collecting data, they should be able to start participating in new models of care, thus unlocking the promised EHR benefits, Sivak said. The future of health care lies in leveraging data. The high adoption rates seen today may facilitate this as long as systems are designed and implemented in targeted ways.