Contributed By Ron Nall
It’s amazing how much more efficient a little information sharing can make things. And nowhere is this currently more applicable than in the U.S. healthcare system.
If each of the various constituents in the healthcare process – physicians, health plans, labs, pharmacies and others – would share the clinical information they have accumulated for individual patients, we could dramatically improve the efficiency, quality and cost of healthcare in this country.
The concept is simple: With more complete and detailed patient data on hand in the form of an electronic medical record, clinicians and care managers can make faster and more accurate decisions. Besides streamlining the entire process, this would help generate better outcomes and healthier individuals and might ultimately grow into system-wide improvements.
If nothing else, it would mean that patients and physicians wouldn’t have to start from scratch each time they have an encounter. In other words, patients wouldn’t have to try to remember and repeat every detail of their medical background to each different physician they see. And physicians would have a comprehensive and succinct “health resume” for their patients.
So if we could bring real change to healthcare simply by sharing some information, why aren’t we? In a word, it’s interoperability, or the lack thereof.
One of the biggest impediments to health information exchange is the fact that, in most cases, the technical systems used by healthcare constituents can’t communicate with each other because they don’t interoperate. As a result, Health Plan A can’t share the information it has with Dr. So-and-So, who can’t send his clinical data to the National Pharmacy Chain, and so on.
Unfortunately, by themselves, these data sets can only benefit each individual stakeholder. If we could combine them, they could benefit us all.
There are several reasons that the health information technology sector has been unable to overcome the barriers of interoperability, not the least of which is the health information technology sector itself, ironically enough. For each technology vendor that has specifically designed its systems to easily interface and interoperate with others, there are those that have dedicated the same amount of resources to ensuring that their technologies are closed or “single source” so they can obtain exclusivity agreements with their customers.
Physicians, health plans and even patients themselves have proven to be obstacles to interoperability because each group maintains its own set of conflicting goals. Physicians and health plans have long had a notoriously tenuous relationship but, thankfully, there have been recent indications that each entity is more than willing to set aside their differences if it means improving patient care.
Despite the fact that Americans have largely accepted and become engaged in the information technology revolutions in practically every other area of their lives, most are still quite wary of similar innovations in healthcare. The simple fact that there are so many different constituencies in the healthcare system itself is also a hindrance. Convincing each to accept significant procedural change alone has proven to be a cumbersome endeavor. Finally, getting them all to implement that change will be an even tougher challenge.
Still, these are all hurdles that can be cleared. Granted, any change in our slow-moving healthcare system will take time, but the key is to start with small and simple health information exchange initiatives through which constituents can become familiar and comfortable with the process. Eventually, larger-scale efforts would logically emerge, with the ultimate goal being a standardized nationwide system of interoperable technologies facilitating a robust exchange of health information. Health plans and physicians will begin to experience the benefits. Patients will see the value, and single-source technology providers will have to change their approaches to meet the demands of clients seeking open-source solutions.
Like most things, the impact of health information exchange that can be achieved through interoperability becomes clear when we attempt to affix a dollar amount to it. This is what researchers at the Center for Information Technology Leadership attempted to do in a 2003 study, The Value of Health Care Information Exchange and Interoperability. The research group created a cost-benefit model that combined published third-party evidence with what they believed to be expert opinion to calculate the value of electronic health information exchange and interoperability between providers, and independent labs, radiology centers, pharmacies, health plans, public health departments and other providers. Their conclusion was that “fully standardized interoperability” between these entities could yield an annual savings of $77.8 billion.
Whether the actual financial impact of interoperability would be as dramatic as the CITL study suggests is open to debate. What is clear, however, is that interoperable technologies in healthcare would improve the system. If exchanging health information through interoperability only meant we could eliminate the need for patients to manually complete the infamous clipboard registration and information forms, our system would be better for it.
Interoperable technologies that facilitate information sharing ensure that healthcare professionals know as much as possible about our health histories when treating us. And when this happens on a system-wide scale, we can change healthcare for all.
Ron Nall is executive vice president and CIO of MEDecision Inc.