Do providers face an electronic health record learning curve? (Part II)
Ron Sims, Rich Moyer, Gail Graham, and Scott Armstrong continue to respond to Wednesday’s question about adoption of electronic health records.
Transcript:
Ron Sims: The original question was, “Who is going to come with the standards?” And I believe you’re going to see the Federal Government move on them with a great deal of aggression over the next couple of years, and there’s several reasons why. If you look at the issues that the three car companies face, one of the things that they’ve been raising on a pretty consistent basis is their healthcare costs, not only their pension costs, but their healthcare costs.
And I think you’re seeing that among all employers, where we’re beginning to say, “Hold it a second, we can’t afford to continue to write these checks,” whether they’re from the tax payers, as in government, or whether they’re from stockholders and you see it in private industry. So I think there’s an impatience with the discussion. And I think what you’re going to see is a tremendous amount of pressure put on the federal government, whether it’s the President or Congress, to come back with some solutions and to do that in a very short order. In addition, if you look at the issues of Medicare, and you begin to project out how long can that be financed comfortably, which is to 2018, I believe, before all of a sudden we have a reckoning? Or how do you basically reduce the federal debt so it’s no longer sitting at 12.3 trillion dollars and it’s going to back off and no longer represents 24 percent of our GNP? People are going to look at the one thing that grows and just screams out at you in need of reform and influence and that’s the healthcare system. So I think you’re going to see a great deal of federal activity, setting standards, setting interoperability, laying out the requirements for what would constitute an efficient and effective health care system. There’re some things though that electronic medical records will not address, and we should be really fair about that. You can’t look at African Americans in King County and look at the number of African Americans who have diabetes, who have amputations and say, “Electronic medical records influence that.” You cannot say that. Having that information isn’t going to reduce those amputations; there is something within the practices that say that African Americans are more likely to be given amputations of diabetes and other people will not. And so those reforms are going to be outside electronic medical records. But a comprehensive set of electronic medical records that have the same kinds of codes in them and standards in them allows us to measure performance so we can say, “Hold it a second, we can’t explain it other than the fact that people are not conscious of other, more subliminal factors in the allocation of treatment.” So I look forward to seeing the standards coming from the Federal Government, common standards across all of them, interoperability from the Federal Government, performance-based systems by the Federal Government. But the measurement systems will not come from the electronic medical records. We will extract that information from them, but they’ll be a separate set. The other thing that I think is going to be important is, and I went back to it, you can’t understand the records, you really can’t. Some of them are just, you just can’t understand them. But I think as the federal government moves forward with standards and as people begin to implement them, where it’s Microsoft and others, you’re going to see a whole other set of technologies that evolve, which will be able to extract information from the records you have and then tell you things like, “Did you, you know, you shouldn’t have been imaged.” Or, “The following drugs you’re on have negative interactions.” And we know that negative interactions among drugs kills a lot of people every year. Or that, did you realize that you got a hospital-acquired infection, and that’s why you were in the hospital that long, go sue your hospital.” I mean, those are the things that I think we’ll be able to extract. But that technology will not be in electronic medical records, we’ll be able to buy that and use it as a tool to interpret our electronic medicalrecords.
Q: So you anticipate potential for much higher levels of accountability, maybe, on the part of providers and payers for the outcomes that the patients experience as a result of the care, coming about as a result of truly understandable and interoperable records, potentially.
Ron Sims: Accountability of the system and the empowerment of the consumer, and we need both. People have to begin to own their decisions and understand those, and the accountability will come with it. You need to do both.
Rich Moyer: I want to talk about, bringing up the consumer, a lot of the discussion we have is about interoperability. And that’s a really technical way of moving data between systems, and it’s a really kind of industry-centric approach. I think we really need to talk more about portability. And that is, I got to get access to my medical record, I should be able to take that, just like I go to my various banks that I have money at and download that information. Once I’ve got that information, there’s a lot I can do with it. I can go to other providers, I can use decision support tools, consumer level, you know like QuickBooks, for banking. So I think one of the things the industry’s done is emphasized portability and really talked more and more about interoperability, which is a big structural thing that costs lots of money and requires huge amounts of resources. I think there are some simple things that if we dedicate ourselves to portability, much as we’ve dedicated ourselves to privacy, that that can empower consumers to take their own data and to help manage their care.
Gail Graham: VA, as many others have done, has done this through the availability of a personal health record where parts of the electronic health record are available for the patient to share with their children or with another physician. But I think it’s the lower tech interoperability; the availability of that data, again, I think is essential for that continuity of care.
Q: Scott?
Scott Armstrong: One other point I would make. I really do agree with the comments about the portability and the importance of our patients having this information and being able to use it as they should. But there are other sources of real value to the populations of patients that we serve that come from the electronic records. Our ability, for example, to know how many patients have been diagnosed with diabetes and to know through our electronic information system, how many of them have had the various checks that they should according to their clinical guidelines. We’re in touch with every one of them, proactively, who has not shown up for those visits that they should be showing up for. This will be a systemic way of leveraging electronic records to improve the health of the population overall, and it’s not just because the patients themselves have control of this information. I think that’s part of the points I’ve made before; it’s great to engage our patients, it’s great to make this information easily available to them. But when electronic information influences how care systems promote the health of the populations that they’re serving, that’s when you’re going to start seeing the real imperative for investing further in these systems.
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