“It was the best of times, it was the worst of times...” So begins A Tale of Two Cities, Charles Dickens’ classic story about the French Revolution.
The quote goes on: “…it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair.”
It’s an eloquent summing up that could apply to just about any time of great change, including the current upheaval in healthcare. As with most major shifts – political, economic, social or otherwise – there will always be both winners and losers. There will be success and there will be failure. There will be those who celebrate the new direction, and those who mourn the passing of an era they loved.
I can understand both of those feelings. As a physician, I can share the sense of loss that many feel as they mourn the passing of an era of independence. Twenty years ago, most physician practices were autonomous businesses. Now most physicians are employed. In another 10 years, you will be hard-pressed to find a physician who is self-employed.
On the other hand, I celebrate the new direction toward more value and better outcomes for patients. Most people in our profession care deeply for their patients and want to see progress on this front, but many are not sure that value-based reimbursement and all the other changes — EMR adoption particularly — will really benefit the patient. So our job is to make sure the changes we make really pay off for patients and for our society as a whole.
It won’t be a slam dunk. Big changes often come with unintended consequences – side effects, if you will – and we all know how problematic side effects can be. Sometimes they are worse than the disease you are treating. So we will all need to be vigilant to be sure that we are moving in a positive direction, not just moving.
Making the new environment work for both patients and hospitals
For hospitals, the change to value-based care will be enormous. Their role will flip 180 degrees. Instead of bringing in patients, they’ll be tasked with helping keep patients out of the hospital. But it is a change that needs to happen, because no matter how good a hospital is, staying healthy and out of the hospital is better than needing to be in one.
Hospitals that are part of an integrated health system, rather than standalone facilities, will fare better under the new system because they will automatically be part of a team effort. The incentives for integrated health systems are clear: They sell insurance, and the healthier their members, the lower their costs will be. That clarity of incentives will help integrated systems move swiftly toward value-based care, and having all members of the care team under one umbrella will help ensure better coordination of care and less duplication and waste. We’ve seen this trend growing over the past few years, with health systems buying hospitals and physician practices.
Data integration will be the next big challenge
One of the biggest challenges hospitals will face in the next couple of years will be data integration. All those mergers and acquisitions in healthcare have turned many organizations into the Tower of Babel, where so many data languages are in use that care coordination becomes a nightmare. To standardize and integrate data, some systems have taken the route of converting all of their facilities to one EHR, but that is enormously expensive and very disruptive, and it ultimately doesn’t solve the bigger issue. The EHR is only one source of clinical data, and as analytics are increasingly important, healthcare organizations will need to integrate data from a wide variety of sources beyond the EHR.
Fortunately, integration strategies are maturing. Many organizations are moving beyond the point-to-point and hub-and-spoke translation arrangements toward a more flexible strategy of federated data integration. With the federated system, data is shared through a central integration engine that can handle a wide variety of data. Essentially, the central integration engine speaks (or can learn) all data languages and translate data to whatever format the destination system needs. That avoids needing to convert all your facilities to one EHR and also allows integration of numerous third party data sources that are useful in population health and in predictive analytics.
Tied to this is the need to uniquely identify patients, as I discussed in “The Identity Problem.” With no unique patient ID number, integrating patient data from disparate sources raises the possibility of mixing data for one patient with the records of another. While technology continues to improve the machining algorithms when dealing with individual patient care, any mismatch can be unacceptable and potentially dangerous.
Finding new ways to serve
The Advisory Board recently surveyed patients about their preferences for minor episodic/acute care. Surprisingly, convenience was a priority, ranking far above seeing the same provider on every visit. Consumers said convenience was more important even than the caregiver being a physician, as opposed to a nurse practitioner or physician assistant, at least for minor ailments.
Hospitals can play an important role in providing convenient access to primary care, through telehealth systems, urgent care options and other arrangements that help patients get care without having to make an appointment and sit in a waiting room for an hour. Having a robust data integration strategy will help ensure that these episodic visits become part of the patient record and that appropriate follow-up and continuity of care happen.
One team, not a fragmented patchwork of individual providers
Ultimately, healthcare transformation will create a more coordinated system. The lone doctor doing it all will become a remnant of history, replaced by a team of caregivers who oversee all aspects of a patient’s care. While some will mourn the loss of autonomy, the patient will win because a smoothly functioning team that supports each other and communicates well can, over the long haul, outperform even the most outstanding group of individual players.
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