In 2010 I was diagnosed with kidney cancer. A bone scan indicated that the cancer may have metastasized to the bone. A surgery was scheduled to remove and biopsy part of a rib in question. The surgeon was to review the bone scan before surgery, but he didn’t. That information didn’t get to him, and he removed another part of my rib.
Unfortunately, there are real costs to the “gap in health information exchange” (see ONC Data Brief No. 20). It goes beyond just a patient’s access to records -- it affects the whole health care system. It’s not uncommon for a test or procedure to be redone because the results aren’t available in a care setting. Hospital’s are trying to lower 30 day readmission rates that currently range from 8% to 18%. A major cause of readmissions is the lack of coordination between Hospital and PCPs (see HCUP Statistical brief #199). And yes, most patients don’t access their health records online, either.
But, something’s different now: there are real incentives to move clinical data between organizations. CMS is assessing penalties to hospitals for not improving readmission rates. The penalties can be significant – up to 2% of Medicare reimbursements in 2017, amounting to millions of dollars to most hospitals (HBR: “What Has The Biggest Impact on Hospital Readmission Rates”). The Affordable Care Act (ACA) has incentives for coordinated and managed care making access to a full set of health data across care settings critical. Over 700 organizations are now Accountable Care Organizations (ACOs), where they manage care across care settings, and split the savings with CMS. However, as reported in Kaiser Health News, “For ACOs to work, they have to seamlessly share information.” (KHN: “Accountable Care Organizations, Explained“). So, for the first time, there are real incentives to move large amounts of health information across different systems, care settings and organizations.
And this large scale movement of data is finally happening. Michigan, Maryland and other states have notifications of hospital admissions and discharges to care organizations and providers across the state. Primary care physicians and care coordinators can now almost instantly know when their patients are in the hospital. What’s more – they can get detailed clinical information as these exchanges add the full summary of care record in the notification.
Another example is population health. A recent grant has enabled half dozen Maryland hospitals in different health systems to share data in a population health effort. Rather than using proprietary methods to access each organizations data – they used an existing, standardized exchange method.
This last point is key: getting access to data has been a major barrier. Policy issues aside, the methods to access data across different systems in different organizations have been very costly. EHRs have not been incentivized to make standardized interfaces to their data. In fact, most EHRs have resisted open means to access data. There are many reasons for this, but having control over there own ecosystem, data and partners is incentive enough for EHRs to resist open exchanges of information.
The good news is: the incentives are winning out over vendor self-interest. This sets up a business situation, which demands secure cost effective solutions for data exchange. New standards created in Meaningful Use, like Direct Secure Messaging, added to existing standards can enable most exchange scenarios.
In the past few years, more and more data is being moved between organizations, while the costs of data exchange have come down. The logical extent of this is clear: health data exchange will become ubiquitous. While the basic standard for Internet email was written in 1982 (RFC 821), it wasn’t until over a decade later when the right confluence of standards, enabling technology and business environment allowed internet email to explode as ubiquitous messaging.
The situation is much the same for health data exchange. The standards are here. The business incentives are here. And the enabling technology is here. Cloud-based SaaS exchange platforms take much of the cottage industry out of interoperability – making it low risk, low labor and low cost. Our RosettaHealth platform is a cloud-based SaaS for exchanging records using any standardized protocols (HL7 V2, IHE profiles, Direct Secure Messaging, FHIR, etc) and costing a small fraction of the exchanges just a few years ago.
Full health data ubiquity is not here yet… but it’s on the horizon. How will you take advantage of the coming revolution?