In healthcare, the seemingly ceaseless mounting challenges confronting providers and policymakers are intertwined, with health IT at the center as healthcare becomes more and more digitized.
At a Cerner media event Tuesday — part of the 2015 Annual HIMSS Conference in Chicago — a panel of healthcare and IT experts from Kansas City, Mo.-based Cerner, Salt Lake City-based Intermountain Healthcare, Danville, Pa.-based Geisinger Health System, Oak Brook, Ill.-based Advocate and CommonWell Health Alliance discussed challenges associated with altering the design and approach of health IT systems as healthcare transforms to emphasize population health management, lower costs and more efficiency.
John Glaser, PhD, senior vice president of Cerner, moderated the panel, which included Marc Probst, CIO and vice president of Intermountain Healthcare, Alistair Erskine, MD, chief clinical informatics officer of Geisinger Health System, Rishi Sikka, MD, senior vice president of clinical transformation of Advocate Health Care, and Jitin Asnaani, executive director of CommonWell.
Panelists identified the biggest obstacle for health IT as the lack of a single, defined set of standards and the subsequent inability to ubiquitously move data between systems. This obviously has profound effects on care delivery. Establishing a set of standards, they said, will get healthcare on track for more effective population health management.
"The technology to move data is not that difficult, but the fact that different systems use data in different ways, combined with a lack of standards, makes sharing data difficult," said Mr. Probst.
In a post-EMR world, it is not the EMR system that is the key, but rather the data that comes out of it, according to Dr. Sikka. Dr. Erskin with Geisinger agreed: "With Apple and the iPhone, it wasn't the hardware or technology that made it extraordinary," he said. "It was the collective capabilities present in one device. That is what we're just starting to do now. The Epics and the Cerners are essential components of this framework, but we need to have the mechanisms that will make all data available to all providers, regardless of what system we each have."
Providers and case manager need access to various kinds of patient data from the continuum of care — including clinical data, claims data and non-healthcare data — to get the full image of the patient. However, a lack of standards for normalizing EMR data and making it computable across systems increases the need for manually "cleaning out data." Data scientists and other health IT workers could be substantially more productive if a consistent set of standards across different systems were in place.
The need for defining a set of standards for data sharing is also essential for providers as they take on more risk, according to Dr. Sikka.
"First, we have health systems, providers and medical groups all interested in taking a greater degree of risk for improved care," he said. "Taking on that risk requires having a full spectrum of understanding of patients. Put that against the further backdrop of increasing consolidation, and you really see that this is a transformation that is needed in our industry — and country — to increase the quality of care at a lower cost."
Beyond the need for ubiquitous data sharing to improve efficiency and efficacy on the provider side, it is also profoundly important to the direct care patients receive. According to Mr. Probst, the lack of standards in this regard qualifies as a "national emergency."
According to Mr. Probst, thousands of Americans are not living well and even dying because of inefficiencies in care coordination and medical errors that occur as a result.
"These standards need to be put in place and legislated," said Mr. Probst. "When has Congress allocated any money or responsibility to get these standards done? It will save lives and billions of dollars."
Another principal issue impeding population health management efforts is the patient- and physician-centric design of the current technological infrastructure, according to Dr. Sikka. There needs to be a paradigm shift to reflect the team-based effort required to deliver on the goals of population health, not on the exclusive patient-physician interaction. By definition, population health isn't centered on a single patient but an entire population. Likewise, it doesn't focus on illness but on wellness and giving people the tools to sustain wellness outside of the physician's office. In this sense, he said technology will be most effective if it is consumer-centric, not patient-centric.
However, the apps and other technological devices designed for consumer activation in population health management efforts cannot come from a one-size-fits-all approach — among consumers there is various degrees of price sensitivity, engagement and segmentation, said Dr. Sikka.