By Brian Schilling
The nation's transition to a truly wired health care system, having progressed molasses-slowly for decades, is now at least a pilot-test reality in a select few markets. And one reason may be the engagement of employers who have long realized the cost-saving, quality- improving potential of having health data zip securely and efficiently among providers, labs, hospitals, and clinics.
"We've turned the corner from talking about it to doing it," said Becky Cherney, CEO of the Florida Health Care Coalition (FLHCC) referring to the dozens of data sharing pilot tests going on around the country. Cherney's coalition of employers and health care organizations is among the leaders in the field. The FLHCC leads its own regional health information organization (RHIO), which is in the middle of a 12-month pilot project. The system allows doctors from the two largest-competing health systems in the area, which includes 10 ten hospitals, to pull records from each other's databases, including full lab reports, radiology results, and discharge summaries.
"Data are available in real time, while doctors still have patients in front of them. That's when it can make a difference," Cherney said.
In practice, pilot project will help prevent area physicians from reordering tests that have already been done, make them less likely to prescribe medications that don't mix well, and, most important, will give them the opportunity to truly coordinate care. The system is currently being expanded to about 1,400 area physicians' offices, making central Florida one of the most wired areas of the country from a health care perspective.
"It's common for patients with multiple chronic conditions to see five, six, even seven different doctors," said Cherney. "If those doctors are not coordinating care among themselves, the patient is going to suffer."
Getting to a working pilot project was not easy. The Florida RHIO, which has been in existence for seven years, spent most of its early years addressing IT challenges, generating interest among health organizations, resolving legal issues, ensuring data security, and deciding where data would be kept (i.e., in a central repository or in a model in which all data remained at the point of origin). The Florida RHIO has tried both approaches, and now keeps data in a centralized location. Cherney won't endorse either model. "No two RHIOs will look alike," she observed. "All health care is local and all data sharing arrangements are local, too. It's whatever works in a given community."
The Florida RHIO boasts support from about 50 large employers. This support prompted the region's two competing health systems to set aside differences and participate. According to Cherney, employers all say roughly the same thing about why they participate: it helps their bottom line.
The coalition conducted a study in 2005, Cherney said, that found about 22 percent of all medical tests were duplicated or redundant tests made necessary because physicians didn't have access to earlier test results. "We would literally see patients get two MRIs in a week. We would see patients get prescriptions for drugs that were obviously contraindicated," she said.
Also key to the Florida RHIO's effort was a grant of about $2 million from the federal Office of the National Coordinator for Health Information Technology (ONC) to help finance efforts. State funding was matched by the Winter Park Health Foundation. FLHCC also contributes money, office space, and staff time to the project. But the Florida RHIO, like most others, is still searching for a sustainable business model. Cherney believes that area employers will continue to support it, including providing financial support. "This effort is entirely driven by employers," she said. "They know there is a tremendous opportunity here to improve care quality and bend the cost curve."
While the Florida RHIO is at the vanguard of such efforts, it's not alone. There are a few dozen other RHIOs that manage similar pilot projects, including efforts in Louisiana, Cleveland, and Pennsylvania. In addition, there are about 150 other RHIOs that exist only as virtual organizations, offering no real platform for data sharing and no meaningful forum for developing one.
Federal Efforts
At the national level, the ONC is moving aggressively to get health data flowing and to encourage doctors to use it. But according to Josh Seidman, Ph.D., Acting Director of Meaningful Use at ONC, providers and employers should not expect the government to step in and impose a system-wide fix.
"The federal government can only be a catalyst here. It's going to take a lot of public–private partnerships to make 'meaningful use' a reality," said Seidman. "Every employer in the country ought to be making sure that their provider contracts are aligned with the push to see that providers achieve meaningful use of health IT."
"Meaningful use" is not merely a pleasant-sounding generalization about integrating health IT into clinical practice – it's a formal set of dozens of criteria doctors and hospitals must meet to qualify for various new and large Medicare and Medicaid incentive payments. These include checking for drug–drug interactions, reporting quality measures, and incorporating lab test results into electronic health records.
For employers, promoting meaningful use will mean building new performance expectations into various contracts, redoubling their commitment to value-based purchasing (i.e., buying health care in a way that promotes quality and cost control) and, if applicable, getting involved in their local RHIO1.
More than a half billion dollars has been spent over the past year to fund states' efforts to increase connectivity among physicians and enable patient-specific information flow more freely. The ONC has also funded 60 Regional Extension Centers in virtually every geographic region of the United States. These extension centers, in turn, will provide on-the-ground support to health care providers as they transition to electronic medical records, help lower barriers to data flow, and distribute free quality measurement and reporting software.
As a result, the ONC expects to meet an ambitious goal: seeing that 100,000 primary care providers in practices with fewer than 10 doctors are engaged in meaningful use of electronic health data by 2012. "That's the high-hanging fruit," said Seidman. "But that's where our efforts will do the most good."
1 "Medicare and Medicaid Programs; Electronic Health Record Incentive Program, Final Rule," Federal Register, 75 no. 144 (28 July 2010):44314–44588.