Caring means sharing.
In an increasingly more accountable world, the challenge is to get everyone in the delivery system on the same page. Effectively communicating across the entire team involved in care, including the patient, is the next frontier. Regulation, interoperability challenges, and organizational resistance are just a few reasons why it’s difficult. Simply put, the system was not designed for collaboration outside of the four walls of an entity providing care.
Value-based care is breaking down barriers.
Value-based contracts are creating the financial imperative to overcome these barriers. With effective contractual linkages between the various players it is much easier to coordinate patient care. This is all predicated on aligned incentives between those same players to improve the quality of care and protect resources. If the primary care provider knows that their patient was recently discharged from the hospital for example, they can schedule follow-up appointments and possibly avoid the risk and cost of a readmission or unnecessary Emergency Room visit. This requires a number of technical and workflow gaps to be jumped, linking disparate technologies, and often times distinct and separate provider groups.
As provider organizations become more sophisticated and contracts become more expansive, we are seeing an uptick in health information exchange. The Centers for Medicare & Medicaid Services (CMS) announced that new organizations applying to the Medicare Shared Savings Program are now required to outline an information technology strategy that dovetails with their proposed clinical and organizational approach to managing care.
Private (or hybrid private/public) Health Information Exchanges (HIEs) formed by providers (especially around new contracts or ACOs) are becoming much more common to address many of these issues by simplifying the variables: fewer organizations, leaner governance, and generally smaller datasets focused around identified operational needs. We expect this trend to continue to gain traction as payers and providers engage in new models of delivery and payment.
Despite the challenges, the momentum is there for sharing data, not only between clinical members of the care team, but with patients and their families as well.
The rise of online patient engagement.
We’re also coming to expect to be able to engage with caregivers outside of the formal office visit or even a phone call. Telemedicine and retail clinics are gaining traction, but rudimentary tools exist in the form of patient portals that are bundled with virtually every EMR. This functionality has been mediocre at best, with usability that is often reminiscent of early 2000’s web pages. Despite the tepid quality of most of these portals, a legacy of Meaningful Use’s requirement for the functionality regardless of its quality, many organizations are leveraging the portal as another and very effective means of patient engagement.
While early reports regarding patient engagement are still mixed, in other aspects of life most people are comfortable doing business online and these portals have the potential to improve convenience and access for patients. Many seniors, traditionally considered late adopters of technology, often request and can now access their Medicare accounts and Explanation of Benefits documents online in many plans. Not to mention all the young people who will be engaging the system too.
How much is too much to share? More than you think.
Many providers are also wrestling with how much information to share with patients, many of whom may not be as informed about how to interpret notes and labs as they relate to their overall health. There are also challenges with patient relationships when documenting conditions like obesity or identifying behavioral health issues without obvious treatment pathways for them. But many primary care providers are seeing positive results from more sharing rather than less.
The Open Notes Initiative, a technological framework for publishing data previously buried deep in the clinical record, is one such example. Patients are finding greater access to their provider’s notes to be helpful in documenting complex conditions with multiple caregivers (who may not all be on an HIE yet) or for simply gaining a better understanding of their overall health. Many providers are reporting that rather than being a burden, open notes actually strengthen the relationship between the patient and provider. Open Notes also has some high profile adherents including M.D. Anderson in Texas and integrated delivery networks like Geisinger Health System and Kaiser Permanente.
Defining what information to share.
There are a number of factors in play with any data sharing strategy. Our recommended approach is built on the bedrock of HIT:
- Choose a target population or issue (value based contracts are a great catalyst)
- Focus on workflows before functionality
- Take an incremental approach
- Solve end-user challenges
It’s an exciting time. You can embrace the challenge, resist, or wait for someone else to tell you what to do.