The true vision of health care reform -- regardless of what the Supreme Court says later this year -- will be a team approach to health care that uses a common data infrastructure to share patient data, make informed decisions and, it is hoped, drive down the cost of care.
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The reality, of course, is quite different. Physicians lack access to the patient data they need, so care decisions are made in isolation and unnecessary treatments continue to drive up costs. Even health care reform's underlying motivation -- saving money -- is under attack, since savings for Medicare and Medicaid translate to annual revenue reductions of up to 15% for hospitals and providers.
The Institute for Health Technology Transformation's iHT2 Health IT Summit in San Francisco devoted a panel discussion to health care reform, the accountable care organization (ACO) and the health IT challenges that make reform difficult.
Team approach to health care means no more 'idiosyncratic' lab codes
The key step will be investing "considerable energies" into improving data governance, said Christopher Chute, M.D., chair of the Division of Biomedical Informatics at the Mayo Clinic.
Here the biggest mountain to climb will be lab codes that can vary among hospitals, if not hospital departments. "Why each lab in the country insists on creating its own idiosyncratic lab codes is beyond me," Chute said, adding that an insistence on "ad hoc specification seems to be a birth right."
Such idiosyncrasy is derived largely from the unique nature of human biology, one attendee noted. While the euro-dollar conversion rate or the price of crude oil are defined by fixed figures, the human body is not. Therefore, many internists are uncomfortable expressing responses to treatment using universal lab codes.
That's all well and good, Chute said, but it still fails to address the team approach to health care and the need to integrate patient data at a population level. Chute noted that physicians in southeastern Minnesota are privy to less than half of all the data pertaining to a particular patient, while hospitals have no way of knowing if their way of treating certain conditions causes patients to seek treatment at another facility.
Addressing these idiosyncrasies requires changes to health IT architecture. Doing so is neither easy nor cheap, which explains why the typical health care organization's data center is a "rainbow coalition" of 20 different systems, said Jim Prekop, CEO of vendor neutral archive provider TeraMedica Inc. That's why data governance needs to start at the front lines, he added.
ACO model lends itself to improved data governance, management
Reform's emphasis on the team approach to health care and the ACO model of shared savings may (intentionally or otherwise) provide a means to this end, panelists said.
In the organizations leading ACO efforts, Prekop said, there's often a systems architect working with the CIO to advise against purchasing closed systems, even it means sacrificing a better user interface. This is especially true of electronic health record (EHR) implementation, said Joe Flynn, president and CEO of Auxilio Inc., since organizations prefer not to make $100 million mistakes.
Chute said the success of an ACO or similar shared savings organization will be made or broken by its ability to manage information. This is especially true of chronic care management, which, as many have acknowledged, represents the first point of savings for health care reform. An accurate, up-to-date picture of an individual patient's care and treatment plan decreases the odds that a patient will "fall off the radar," he said.
Pay now, save later with team approach to health care
Of course, the combination of the team approach to health care and the loss of revenue from shared savings likely means physicians will be responsible for more patients. That's a hard sell. So is the understanding that the benefits of the team approach to health care will be realized in the long term, while the costs -- both in shifting the focus from corrective to preventive care and in updating antiquated health IT architecture -- will be borne in the short term.
Why each lab in the country insists on creating its own idiosyncratic lab codes is beyond me….[A]d hoc specification seems to be a birth right.
Christopher Chute, M.D., chair, Division of Biomedical Informatics, Mayo Clinic
Brent Hardaway, vice president of engagement and delivery for the Premier Healthcare Alliance, said his organization has identified six key components of an ACO.
- A patient-centered foundation.
- Use of the medical home model.
- A high-value network.
- Administration over structure, governance and equity.
- Population health data management.
- Payer partnerships, since such entities can afford to take risks.
"Very few hospital-based systems have these components," Hardaway said, adding that layering payer model on top of this makes it "extremely difficult to succeed."
Ultimately, Flynn said, large health systems -- which are poised to get larger as independent physicians join in lieu of bearing IT implementation and health care reform costs alone -- will have to start behaving like corporations to fully achieve the benefits of the ACO model.