Thursday, July 7, 2016

The Positives and Perils of Patient-centric Approaches to Healthcare Data

By Matt Patterson, M.D.


Imagine a future in which dozens of different patient-centered technology solutions compete with one another, contributing to a disastrous combination of higher costs, lower-quality care and scores of angry and confused patients. Without robust health information interoperability, this scenario is a very real possibility in the U.S.   

The need for interoperability comes at a time when healthcare is under extraordinary pressure to improve overall care quality and cost efficiency. The Affordable Care Act is tightening the screws even further on the revenue side. For these reasons, it is understandable that health systems are eager to deploy a patient-centric approach to data portability and interoperability. 

The good news is that in both private and public discussions with health and policy leaders, there is encouraging talk around interoperability through open and available application programming interfaces (APIs), which allow health data solutions to communicate with each other. Public comments by Health and Human Services Secretary Sylvia Mathews Burwell and Centers for Medicare and Medicaid Acting Administrator Andy Slavitt support this analysis. 

While imperfect, a patient-centric approach is currently the best framework available. Individuals should own their data and have easy, real-time, plain-English ways of opting in and out of recording and sharing data in both identified and de-identified ways with anyone they wish, to benefit themselves and/or society at large. 

However, the patient-centric approach is not a cure-all. In fact, Meaningful Use Stage 3 – and its requirements for making data available to patient-facing applications – could result in unintended consequences for clinician workflows.

The stated purpose of Meaningful Use is to leverage certified electronic health record (EHR) technology in stages to improve quality, efficiency and care coordination while maintaining the privacy and security of patient health information. The hoped-for results in Stage 3 include improved outcomes.

Yet Meaningful Use and open APIs for consumer-facing applications will not be enough to solve the interoperability challenges we face. For example, imagine an emergency department physician ordering tests for a patient who knows those tests were already recently done by another provider. Even if that patient has an application on his or her phone that can access data from various sources, it is still unlikely this could translate to a scalable, reliable, effective workflow for the physician. The more likely results are already familiar to those dealing with ineffective health information exchanges (HIEs): incorrect data, a difficult-to-navigate solution, a failure to tailor the focus to the specialty of the user, or suboptimal data provenance, to name a few.

By relying too heavily on a patient-centric approach, we risk diminishing momentum toward the real game-changer: enforcement of affordable, open, bi-directional APIs among all health information systems. This is a must-have on the road to innovative and intuitive workflow solutions for clinicians and consumers. Referring back to the scenario above, ED physicians need access to an integrated workflow that incorporates their own hospital’s data, along with relevant patient data from multiple other disparate sources. This will enable more cost-effective, efficient and clinically accurate decisions.

While this may sound idealistic, it is absolutely achievable. We can start by putting the consumer in the driver’s seat as the broker of his or her data in ways that reduce unnecessary complexity. For example, the creation of a simple consumer-facing application that simply has two buttons - ‘Record’ and ‘Share’ - would provide control over an individual’s data and interoperability in an easy, real-time way. From there, wide-open, bi-directional interoperability among the patient’s historical data sources can support nimble, innovative workflow solutions geared toward clinician use and faster, more informed decision-making. 

Another benefit to giving the patients real control over their data is the potential to finally expose the overt data blocking that exists today. Data belongs to individuals. Those acting as gatekeepers should no longer be able to profit from blocking access. The gate should be unlocked to create innovative workflows and value from this data. Ultimately, business models that simply monetize the hoarding and simple transmission of data from closed, Byzantine health information systems without creating meaningful insights and workflows will crumble – as they should.

With all this in mind, health systems seeking to innovate with patient-centric technology solutions should support open APIs and discourage data blocking practices from their incumbent vendors. And, by partnering with technology firms that offer demonstrated interoperability and workflow innovation capabilities, these health systems can create tools that improve the lives of patients and those who care for them.  The results can have a powerful impact on both individual patient care, and the broader healthcare system.

Dr. Matt Patterson has built his career around the goal of delivering better quality healthcare to more people at a lower cost. Responsible for operations, he leads AirStrip's people, processes, and technology required to deliver the full value of AirStrip mobile solutions to clients. Dr. Patterson joined AirStrip from McKinsey & Company, where he was a core leader in the North American Healthcare practice's strategy and operations engagements. He focused on clinical and business model transformations of major U.S. health systems transitioning from "pay for volume" to "pay for value" environments.

Dr. Patterson also brings a wealth of clinical and operational leadership from his experience as a former U.S. Navy physician, where he served as the Medical Director of the Naval Special Warfare Center in San Diego, CA—the elite training command of the U.S. Navy SEALs.

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