Can HIT Live Up to the Hype?

The Association of American Medical Colleges (AAMC) predicts the U.S. will face a physician shortage over the next decade. While many physicians agree that we need more doctors, a New York Timesarticle concluded the healthcare system doesn't need more physicians, it needs more efficiency.

"We don't account for advances in technology, like telehealth and new drugs and devices that lessen the burden on physician visits to maintain health," argues the author, Indiana University School of Medicine Professor Aaron E. Carroll.

Here lies the gap between expectation and reality. When it comes to reducing inefficiencies in the healthcare system, telehealth and new medical devices can't be the cure-all. They can't cure the big issue we need to address: In the shift from the traditional fee-for-service model to value-based care, physicians are being asked to restructure their practices while also increasing efficiency. Accomplishing both at the same time is a daunting task.

This transition to value-based care is further hindered by the complexity of quality measures and gaps in patient data accessible to the physician. In a survey by Quest Diagnostics and Inovalon on "Finding a Faster Path to Value-Based Care," 74 percent of physicians said that quality measures are too complex. Sixty-five percent said they do not have all the healthcare information they need about their patients. These are significant barriers to the delivery of care based on value and quality rather than quantity of services.   

Physicians agree they need tools to overcome these challenges, but you won't find the technology that will revolutionize the way we deliver care on a patient's wrist or available for download to a mobile device. Instead, a more likely place to find the solutions with the greatest potential to optimize the health system are right under the physician's nose: the electronic health record (EHR).

Before I tell you why the EHR holds the key, let's agree on concerns that are on the top of physicians' minds and where support is needed:

•Patient care: Most of us entered the medical profession to make people well, and caring for patients has always been our top priority. To achieve this, physicians need to fully understand a patient's medical situation and current needs. If a doctor can't see what test the patient has already had or lacks access to prior diagnoses, how can he or she put the patient at ease and suggest the right treatment approach? This gets harder as time with patients gets shorter and shorter.

•Financial sustainability: Concerns related to patient care will always come first, yet some physicians understandably have anxiety about the financial stability of the profession. As value-based contracts increasingly shift some financial risk to physicians, many are anxious about how this will affect their livelihood. We must not lose great caregivers because the economics are unsustainable.

•Administrative complexity: Financial anxiety is high in part because the new performance measures required for reimbursement are so complex. From government and self-appointed oversight bodies to health plans and major medical societies, physicians now confront coding requirements and quality steps that are not only onerous, but that can differ from patient to patient.

What's the key to overcoming all this complexity and financial angst? The key is data. Yes, data.

Health information technology is playing a critical role in delivering data to the point of care when and how physicians need it. And, as healthcare leaders are realizing, this can happen with the EHR. According to a recent report from KPMG, "when EHRs capture and share quality data, their value is multiplied exponentially." In a poll conducted by KPMG with the College of Healthcare Information Management Executives (CHIME), 38 percent of executives surveyed said EHR optimization is a top priority over the next three years. However, EHR optimization is not a top-down initiative. The report calls for organizations to assemble cross-functional teams – including clinicians – to execute a strategy to ensure EHRs are delivering actionable insights that drive strategic decisions and, ultimately, improve patient care.

This type of finding will likely resonate with physicians because their greatest concern is caring for their patients. They don't necessarily love technology or data, and they don't consider themselves experts on value-based care models. Physicians do, however, want tools that make it easier to identify and close gaps related to care, quality, risk adjustment, and patient history. Data analytics, built into the EHR and workflow, are vital to making healthcare more efficient in the future.

EHRs aren't the only pathway to overcoming obstacles to value-based care, but they are one that is available and well-trodden. Until now, some considered EHRs unnecessary hype, but perhaps we just need to hit a different gear before we can accelerate. And new technology and data can help us get there quicker.

L. Patrick James, MD is chief clinical officer for health plans & policy, medical affairs at Quest Diagnostics. With Inovalon, the company also provides Data Diagnostics, a point-of-care analytics platform, to help physicians align health care with quality and other value-based metrics.