HealthBeat talks to Janet Marchibroda, chair of BPC’s Health IT Initiative, on health IT progress, disappointments and hopes for the future. This interview was originally published by iHealthBeat. You can read the full forum here.
What was the most significant health IT development over the past year?
The most significant health IT development in the past year has been the considerable expansion of patient engagement requirements within Stage 2 of CMS’ Medicare and Medicaid EHR incentive programs. Beginning about a year from now, patients who are either discharged from the hospital or seen by an eligible professional will be able to view online, download or transmit to a third party health information contained in their record. Many will also be able to send a secure message to their clinicians. Meaningful use requires that a certain percentage of patients actually do so in order for providers to receive their incentive payments.
This is important for many reasons. First, it’s just the right thing to do. Patients have a right to their health information — a right that has actually been established by previous law. Providing this information electronically will enable patients and all of those who deliver their care to better coordinate care, which has a positive effect on cost and quality. Patients who are more informed and engaged in their health and health care are better able to manage their health. Importantly, research also shows that patient engagement and communication are associated with lower health care costs, improvements in functional status and better outcomes.
Empowering patients through the use of electronic tools creates whole new opportunities for promoting wellness and management of chronic conditions, accountability and coordination, and research on what works and doesn’t work in health care. When combined with increased accessibility to genetic tests, electronic tools can lead to a set of patient-centered platforms that can begin to deliver personalized medicine based on our personal DNA and other factors that determine how we respond to diet, exercise, medicines and various modes of treatment.
Clinicians, hospitals and other providers also have a lot to gain from investments in the work flow changes and technologies that will enable further patient engagement. Better outcomes in cost and quality — which will be required under rapidly emerging delivery system and payment reforms — are probably the largest benefits for providers over the long term. Providing these services will also result in happier and more loyal patients. Finally, the research does show that better patient communication is associated with fewer malpractice claims, which will have a direct impact on costs for providers.
What was the biggest disappointment or missed opportunity in the health IT space in 2012?
Concerns about rising costs and uneven quality of care in the U.S. have spurred the launch of several new delivery system and payment reforms. In addition to a multibillion dollar investment made by the Center for Medicare and Medicaid Innovation, a majority of states and a significant number of provider organizations and health plans have launched accountable care arrangements and/or medical home initiatives. As noted in our recently released report, these new models of care require a robust IT foundation to be successful, which includes effective methods for sharing information among those who deliver care and services to patients, strong data and analytical tools, and robust use of electronic tools that are designed to engage, communicate with, and even monitor and deliver care remotely to patients.
While many aspects of meaningful use align with the needs of new delivery system and payment models, we have still fallen short of truly aligning our investments in health IT with these new models of care on the ground as these various efforts are operationalized. This alignment will require a holistic and broad, strategic approach towards the use of information and IT for all aspects of health and health care, with leadership by both the public and private sectors at the national and local levels.
One of the most pressing priorities for the U.S. health care system is to find ways to enable information to flow electronically, while effectively managing privacy and security, across the many settings in which care and services are delivered, including primary care providers, specialists, hospitals, laboratories, pharmacies, health plans, long-term care organizations and even the patient. Despite the critical role that information mobility plays in improving the cost, quality and patient experience of care and these new models of care, there is very little information exchange occurring in the U.S. today. It is imperative that we address this issue — as an industry and a society — in a substantial way in 2013.
Looking forward to 2013, what are the biggest remaining barriers to widespread adoption and meaningful use of health IT? And, what can be done to help address those challenges?
The most recent EHR adoption and meaningful use payment figures show that we’ve made great progress over the last year with respect to both. However, gaps in adoption particularly among small physician practices — where a majority of U.S. health care is delivered — remain. There are also gaps in adoption among specialists and small community and rural hospitals. While a majority of clinicians wish to share information electronically and believe that it will have a positive impact on health care, they lack the ability to do so.
Government leaders at the federal and state levels and private-sector leaders should come together and collaborate on the development and implementation of strategies that will support this transition, particularly among small physician practices and small hospitals. This can come in the form of training and education, development and widespread dissemination of best practices and on-the-ground implementation support. Programs that support health IT adoption and delivery system reforms should be integrated. Innovative new approaches that can scale and be widely deployed quickly should be considered. Ideally, public- and private-sector investments should be aligned.