HIE ROAD TO CONNECTED CARE

With all the hype surrounding the ARRA incentives for implementation of EHR systems (which, by the way, will not be available until 2011), $2 billion already appropriated for discretionary spending starting this year, including an "HIE Grant program for states or state-designated entities", have been relatively unnoticed so far. In part, this can be explained by a low level of adoption of health information technology in general. Besides, most of regional and state HIE initiatives came out of government offices, were largely funded by federal and state grants, whereas actual participants were not entirely convinced on benefits of those exchanges. They may get a little more exited now, since the definition of "meaningful use" of EHR will almost certainly contain exchanging patient information as well as reporting on quality measures. In addition to that, the need for cost containment seems to gain more publicity, which may result in phasing down the "fee-for-service" payment model and replacing it with an outcome based one. This will provide a powerful incentive for wider use of patient data collected by other providers.

I have no doubt that there is a lot to be gained from consolidated patient information being accessible to providers, delivering care. It can minimize risk of errors, adverse reactions and side effects, and help avoid duplicate and unnecessary diagnostic and treatment procedures. But this is not all. In one of my previous blogs, I mentioned a few other benefits on a larger scale, which assume data mining and statistical analysis. My only reservation is emphasis on regional and state-level HIE, which potentially limits the completeness of patient information, available through each of them. Every year millions of Americans graduate from high school, college, university, relocate to pursue their career, or retire to a warmer climate. Quite a few of them move out of state. Unless there is a way to access patient records from outside of state HIO's, their full potential will never be realized. Frankly speaking, I would rather prefer a nationwide HIO (NHIO), which would store patient data in a unified fashion. Sure, there are differences in state laws and regulations regarding privacy protection, but they could be applied when the data is retrieved, not when it is stored. At the same time, I understand the rationale to utilize already existing and emerging state-level HIO. In 2006, HHS contracted AHIMA Foundation of Research and Education to run the State-level Health Information Exchange Consensus Project, "… to ensure all health information exchange activities throughout the Unites States align".

In order to account for likely heterogeneous systems of participating entities, the Nationwide Health Information Network (NHIN) was architecturally designed, basically, to provide capabilities to locate and link patient records residing within those systems, to ensure interoperability, and to implement authentication and authorization services on the inter-system level. This project is in its early stage yet, most of these functional areas need further drilldown, but the complexity of the structure is already obvious. I believe we can expect some clarity on whether more uniformity will be required from participats, or NHIN will become a very intricate formation with complicated overhead. Stranglely enough, the NHIN project was not even mentioned in the presentation of the HIE workgroup in today's meeting of the Health IT Policy Committee, which, apparently, demonstrates a certain disconnect between different branches within ONC…

HEALTHCARE REFORM: A BALANCING ACT

There are clear signals from Capitol Hill, which suggest that the idea of public healthcare is unlikely to gain traction in either chamber of Congress. Proposals in the works are aimed at preserving the existing market framework, while making health insurance more affordable, covering patients with pre-existing conditions and curbing healthcare spending. Whether the reform is going to work basically depends on how well individual and group interests will be aligned towards maximum efficiency in applying care.

The first, and arguably, most important aspect of any solution is to change the economic environment on the supply side, by drastically reducing use of “fee-for-service” compensation, which generally encourages waste and marginalizes preventive care, and replacing it with value-based reimbursement system. This is supposed to re-focus providers’ attention from selling more services within their domain, to achieving best possible outcomes with fewer resources, in coordination with everyone else involved.

On the supply side, cost sharing is proposed, in the form of higher out-of-pocket expenses and/or deductible. In theory, this should make consumers inclined to take more responsibility of their own health and chose higher-value care when they need it. At the same time, some patients tend to cut back even on necessary services with little regard to their actual value. To mitigate this side effect, patients need to have access to information about their health status and ways to improve it, as well as to be offered incentives for taking good care of themselves. Perhaps, something like a “health score” would help with setting goals and creating a program to achieve them.

In order to be successful in the long run, healthcare reform has to be comprehensive, but to be adopted, it must:
· have support of the most influential stakeholders, not just public at large
· be deficit-neutral during implementation
· have immediate tangible positive effects on a majority of Americans

There is a lot of explaining required from the Administration and Congress, especially on the last two bullet points, to prove that we will have the right treatment for our healthcare.