Technological developments in the health care sector hold great promise for delivering a better standard of care in the United States. But just because you build it doesn’t mean they will come. Doctors, that is.
Electronic prescriptions are a good example. The majority of doctors in the U.S. have no idea if the prescriptions they write actually get filled by the patient. Surescripts, for example, has a platform that lets doctors send prescriptions electronically and track when and if they are picked up.
The technology is there. But Seth Joseph, vice president of corporate strategy at Surescripts, says doctors may be reluctant to access that data and check in on a patient outside of an appointment.
“We have doctors that say ‘what would it mean from a liability perspective if doctors had access to that info and don’t take action’,” says Joseph. There are also questions around how long a doctor should wait before getting in touch with a patient about not picking up medications, for example, or what other steps they should take.
The 2009 Health Information for Economical and Clinical Health Act (HITECH Act) incentivized health care providers to adopt electronic health records (EHR) systems and use them in specific and meaningful ways. One of these is for EHR systems in one office to connect with EHR systems in another — a hospital, for example.
As a testament to how well the incentives have worked, Joseph has noted a surge in the number of EHR providers alone. His company currently connects with over 300 EHR vendors — up from just under 100 in the first quarter of 2009. By 2012, the company had seen a flood of EHR vendors, which he documented in a recent study. Considering that Surescripts was founded in 2001 and active by 2003, that’s a significant bump in a three-year period.
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Some hospitals and emergency rooms can already query a network of health care providers about a new patient, to see if that patient has received any prescriptions in the last 13 months and from whom. Some of these networks even have email and chat functions.
But for the most part, doctors don’t coordinate care with caregivers at other facilities using electronic systems. A general practitioner may be able to make an electronic referral specialist, but they can’t manage a patient’s overall health regimen.
As it stands, doctors are paid mainly on a fee-for-service basis, which conflicts with the whole notion of coordinated, preventative care. Rather than making doctors responsible for a patient’s overall health and incentivizing them to provide follow-up care (like checking in with doctors or services they’ve referred patients to), the current system encourages doctors to provide as many single services in a day as possible — leaving little time for follow-up care.
“We need to see payment reform,” says Joseph. He goes on to say that new legislation needs to shift doctors away from a fee-for-service model and towards incentivizing ongoing care.
This would require Congress to enact new laws that enable doctors, nurses, or case managers to focus on the whole “patient journey” whether well or sick. Until then the movement to coordinate care is not likely to progress quickly, he says.
Still, there’s promise managed care will catch on without a new law, Joseph goes on to say. Federal Medicare programs are already offering accountable care pilot programs in which health providers are paid a set amount to manage the health of a given population. Experiments in public health programs often lead to broader changes in the market.
In the coming years, we’re likely to see the health care system moving away from the fee-for-service model and toward one that prioritizes preventative and managed care. As the system transforms itself, the people in it will have to answer questions about liability, reassess the role doctors play in a coordinated care schema, and potentially create the new role of a health care manager who can utilize digital records to better supervise patient health.
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