05.15.17

Filling the gap: EHRs, interoperability and value-based care

Value-based care is a critical goal, but one that can be complex to operationalize. And yet, it is well worth striving to achieve. Getting there requires a connected healthcare system that does not yet fully exist. I recently collaborated with colleagues and the American Medical Informatics Association to co-author a paper detailing this gap—the chasm between our current health IT ecosystem and the ecosystem that we need to solidify—a crack that must be closed if true value-based care and a learning health system are to be realized.

Together, we identified a set of goals and realistic actions necessary to ready our current health IT ecosystem for a transition to patient-centered, value-based care. In taking the time to investigate perspectives of the patient, the provider, the researcher and the innovator, we explored, among other issues, EHR data exchange, access and security from each perspective. We coupled these with policy recommendations in a multi-pronged approach to needed changes. Here, I discuss but a few highlights; please reference the entire document for the sum of our proposals. 

Improve patient access to data, and enable data sharing between both the patient and the provider.

Achieving this goal involves multi-faceted tasks that demand careful consideration. Doing so will benefit from changes to HIPAA that protect consumers while enabling infrastructure that grants patients access to not only their own data, but also clinical data and biobanks. Patients, too, need the ability to submit self-generated data relevant to their care, and providers will need standards and functionality to utilize it. 

Improve the provider’s ability to facilitate patient care with immediate and complete access to patient data, least possible time spent on documentation, and easy reference of knowledge-based tools.

While the lack of true interoperability is at the core of many of the barriers to a connected, value-based healthcare ecosystem, those on the front lines of care deal with the resulting inefficiencies (and burdens that accompany them) every day. How can we mend what’s broken? Key elements include enabling interoperability, leveraging APIs, simplifying documentation and quality measurement, and eliminating the dreaded “note bloat” – all are ideal opportunities for improvement.

These are but two of the major categories of effort that we must address if we are to create a healthcare ecosystem that enables evidence-driven, value-based care, and evidence-generation through practice. As health professionals, we are all too familiar with the gaps preventing us from attaining these goals. But by leveraging what we know and committing to the changes required to improve—on an individual, organizational and policy level—we will ultimately deliver high-value standards of care. 

My colleague and CEO of Signet Accel, John Raden, and I share the strong belief in a patient-first approach to both health care and health data exchange. A seasoned executive in the HIT field, John has a unique and knowledgeable perspective on health IT and its role in a connected health ecosystem. Read his POV, rooted in experience, in full, No Patient is an Island: A Patient-First Approach to EHRs and Interoperability,” for a view of how EHRs can reach their full potential.

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