Why the inability to exchange data stands in the way of accountable care

For healthcare organizations to coordinate care and improve treatment for patients, doctors need to know what’s been done for a patient—at a minimum.

A recent survey, results of which were released last week, detailed some disturbing trends regarding the state of information exchange in healthcare.

To make a long column short, the crux is this—information exchange is not happening to the degree that it needs to happen, especially if we believe that we’re going to change the underlying incentives that undergird the reimbursement system for healthcare.

Worse, we can’t fully blame technology for this lack of information exchange. The reasons lie deeper, reflecting the difficulty of breaking out of past models of care that did not emphasize widely sharing patients’ healthcare information.

The survey was conducted by Nielsen Strategic Health Perspectives and sponsored by the Council of Accountable Physician Practices. It involved 30,000 consumers and 626 physicians. Results from both groups were disturbing enough that discussion of the trends in both areas needs to be studied and acted upon.

Today, I’d like to focus on the lack of information sharing acknowledged by physician respondents. According to the survey, patient information is still not often shared across providers. In fact, only 49 percent of physicians with EHRs said that they can share patients’ records electronically with clinicians outside their practice. That’s disconcerting, because it suggests that there can be disconnects in communications, errors in handoffs and missed opportunities for coordination of care. Sometimes that means additional, unnecessary expense, but it raises the risk—in a complicated care environment—that patient safety can be compromised.

In addition, a mere 64 percent of surveyed doctors with EHRs reported that they receive information on hospital discharge summaries. I’m sorry, but the fact that 36 percent don’t receive this information is just sad and unacceptable. It used to be a bit funny that physicians didn’t know information about their patients once they got into a hospital for treatment. Five years into the push to broadly implement electronic health records systems across the industry, it’s lost its humor.

Further, only 60 percent reported that their primary doctor has access to any hospital or ER visit records without them bringing them to the physician office. And only 63 percent of surveyed consumers said that if their doctor is not available they could see another provider who has access to their EHRs.

Taking the positive view of this, there is obvious progress being made. Half to two-thirds of physicians are getting some information on their patients.

But this far into the electronic record transition, those numbers have to be higher, or at least rapidly rising. If EHR systems are now ”table stakes” for providers, as former CIO Adrienne Edens termed it, that means that the basic transfer of basic patient information also must be the norm for the vast majority of providers.

And there’s so much more that needs to be done. Just like it’s now important for providers to optimize their use of electronic health records systems, they also have to optimize the ways in which they exchange health data. For example, it’s not enough for physicians to just have access to shared patient information—it has to hit them at the right time, when they’re taking care of that patient, without requiring a lot of visual focus, technological or mental translation. It needs to be there when and where needed, so they can easily comprehend what it means, integrate it with what they know and what they’re seeing from the patient in front of them, and available to make the best possible decisions.

Yes, this is a quantum leap beyond just getting the information or knowing it’s available. There’s a lot of work to do before technology is able to take records from diverse systems and harmonize it all for clinician consumption.

But for accountable care to really work, it’s got to happen. Some of the chief benefits of accountable care include care team coordination, prevention of illness/sickness, healthcare services available when needed and evidence-based medicine. Those and other benefits are not commonly available now.

But that’s the burden that providers are being asked to accept as they move on to accountable care. As a nation, we really can’t afford another failed experiment in a potential reimbursement approach. If we’re going to say that the key tenets of accountable care are things we believe in, we need to have the technology in place to support it, and approaches to care need to be redesigned to take advantage of all that technology is able to offer.

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