Janice Nicholson is CEO of i2i Systems.
As someone who has spent over 20 years focusing on the needs of healthcare organizations, I have experienced firsthand their unique challenges while using technology to improve patient outcomes. I think we have a major dilemma when it comes to health IT and it’s time we call it out.
First, let’s get right to the heart of the matter: What factors limit health IT’s ability to support quality measurement and quality improvement?
My response is based on field experience in supporting hundreds of clinics and practices who are using more than 30 different Practice Management (PM)/Electronic Health Record (EHR) systems. I would like to tell you that we have figured out why health IT investment has not resulted in more dramatic improvements to outcomes of care, and that we have the solution — but we do not.
What I can share with you are three of the top challenges we have experienced in helping organizations realize the benefit of health IT adoption.
Limitations within EHRs yield roadblocks
The first challenge is that of standards and interoperability. EHR makers claim the records interoperate, but what they don’t say is at what level. Much of the data in EHRs about patients is customized, unstructured data. Even within the same EHR, templates allow a patient’s medical data to be stored in different locations of the database using different representations. This means that while you think you may be accessing information at one end of the EHR, the information you really need might be on the other. This lack of EHR vendor standardization and inability/unwillingness to share customized, unstructured data cripples efforts to address Meaningful Use (MU) and severely limits the analytic capability of EHR data.
Health IT capabilities are behind the times
The second challenge is that EHRs do not fully support MU requirements. Our current health technology isn’t able to analyze data in a way that would allow us to support tactical, operational, and strategic improvements in public health management. This primitive state hampers organizational leaders, management, and even care teams from proactively monitoring and improving performance. To meet requirements of MU Stage 3, organizations need tools that will support long-term, sustainable change.
A simple example of this is HbA1c testing for diabetic patients. Evidence-based guidelines suggest that A1C screening for a diabetic patient should occur at least twice during a year-long period. This simple adherence tracking for one patient becomes complex very quickly when managing population health for thousands of diabetics.
A lack of incentives creates stagnancy
The third challenge is lack of incentives to achieve higher levels of performance. We often see organizations drawn to our solutions mainly for required reporting to payers. We encourage organizations to leverage our tools to their fullest, but sadly, many are satisfied with threshold performance since there are not enough incentives for them to dive deeper into what’s available out there. This speaks to the lack of a data-driven culture incented to measurably improve health outcomes.
Challenges provide the opportunity for solutions
Despite all these challenges hindering the healthcare industry’s ability to successfully move forward in using technology to their advantage, I see various opportunities.
First, Health IT vendors must provide clinics open access to their data, and remove barriers to standardization and interoperability. Performance can then be measured in a reliable way and shared across the health system.
Second, we need to face the reality of what EHRs currently deliver. There is no single, comprehensive, all-inclusive Health IT solution that will meet everyone’s needs today and in the future. Rather, the real solution lies in cultivating a healthy and diverse Health IT ecosystem. We have to help providers understand the intelligence tools they need so they can plan and budget for what will be required to monitor, improve and sustain health outcomes.
Third, we need to increase the percentage of revenue directly related to pay-for-performance. Organizations must be incentivized for behaviors that drive change. This will naturally catalyze the quality life cycle that results in high performance.
We can be optimistic if we address these opportunities. Success is within our grasp and it can come at a price that you, me and the rest of the nation can afford.
Before founding healthcare software provider i2i Systems, Janice Nicholson worked as a software engineer and played a major role in developing a patient management system for private practice. She has managed over 10 major product releases; and, prior to its acquisition by WebMD, she served as the vice president of product engineering at HealthPro Solutions.
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