Will Big Brother Save Healthcare?

May 1, 2007

Healthcare organizations share a common vision: Attain improved safety, efficiency and quality of patient care. The problem lies in what they don’t share—common application standards, system interoperability and a regulatory compliant and competitive environment conducive to partnership. These challenges have undermined previous collaborative efforts, including the past failures of Community Health Information Networks (CHINs) and other health information exchanges. Instead of working together as industry partners, the current landscape positions their organizations as competitors, greatly hindering the development of enterprise interoperability and, eventually, organizational sustainability.

Healthcare organizations share a common vision: Attain improved safety, efficiency and quality of patient care. The problem lies in what they don’t share—common application standards, system interoperability and a regulatory compliant and competitive environment conducive to partnership. These challenges have undermined previous collaborative efforts, including the past failures of Community Health Information Networks (CHINs) and other health information exchanges. Instead of working together as industry partners, the current landscape positions their organizations as competitors, greatly hindering the development of enterprise interoperability and, eventually, organizational sustainability.

The current environment continues to tax the healthcare industry as it faces rising costs, declining provider satisfaction, and growing consumer demand for patient empowerment. With the growing number of players, there is an increasing need to recognize that industry cooperation, and ultimately collaboration, is becoming more important as information and information system requirements become more complex (consider the additional demands and complexity of increased data related to genetic markers and DNA).

The solution may come from an unexpected source—the Federal Government. Typically providing more of an oversight role than a participatory one, the U.S. government has taken a strong interest in the current state of healthcare and its lack of connectivity and unified access to patient data, especially with regards to future plans for national surveillance of healthcare information and trends. Without doubt, the implications of direct government involvement will impact healthcare on every level.

Many healthcare stakeholders find the idea of increased government involvement to be an alarming precedent for the industry. However, history teaches us that this is not an atypical occurrence for our country. Considered one of America’s greatest presidents, Franklin Delano Roosevelt succeeded in bringing together disparate stakeholders through legislated standards, guidelines and incentives to create the New Deal. This expansion of government’s role to address the crises resulting from the Great Depression led to the creation of Social Security and the Securities and Exchange Commission. Another example is Woodrow Wilson’s successful drive to pass the Federal Reserve act, creating the Federal Reserve System. In both cases, government’s far-reaching leadership resulted in the development of nationally accepted standards and organizational bodies that protected and encouraged the stability and growth of the nation.

Already, the U.S. government has taken action in establishing guidelines to ensure the security and privacy of patient data with the passage of HIPAA. Now, government involvement is focused on the creation of standards to encourage real-time data exchange and streamlined access within and between authorized organizations. These standards will contribute to the development of interoperable healthcare IT applications, which is acknowledged as a critical foundational component for reducing implementation costs and increasing widespread adoption of electronic health records within the industry.

The next step, embraced by government and many healthcare leaders, is to link patient records through regional health information organizations (RHIOs) and, eventually, through the Nationwide Health Information Network (NHIN). This nationwide access, combined with state-level (or regional-level) centralization, fulfills the industry’s need for localized control while addressing the government’s aspiration to build a biosurveillance platform to detect emerging diseases and bioterrorism threats.

To achieve an effective, secure NHIN, it is important to begin aligning healthcare strategies immediately. In the case of state health information exchanges, these ongoing initiatives should be used as pilot sites for testing and implementation of standards-based RHIO development and deployment. The pilot sites will deliver significant data, trends and insights that could influence the final structures, communications methods and technologies of the RHIOs and even the NHIN.

Additionally, by incorporating industry-accepted application standards into current RHIO deployments, even RHIOs with disparate technologies will be able to interoperate within the future NHIN.

Government’s role in incentivizing and, at times, legislating industry compliance with regards to patient data exchange and access standards will bring major benefits to all healthcare stakeholders.

Patients. With an implemented state and national health information network, patients will benefit from improved quality and safety of care. Additionally, patients will gain increased access and control of their own healthcare records and services, as well as the ability to change providers while keeping their (electronic) medical records intact and readily available. Moreover, the move towards transparency in healthcare costs will allow consumers to vote with their feet when costs exceed expectations.

Providers. By incorporating standardized data exchange, healthcare IT applications can provide patient information to clinicians within an intuitive, dashboard format that delivers all relevant patient data within one, customizable view for the clinician. This real-time, unified access to patient data results in a significant increase in provider productivity, reduced medical errors, and improved clinician decision-making and patient outcomes. Furthermore, this standards-based automated system will contribute to faster and more complete reimbursement for health services provided.

Payers. A unified healthcare system lowers operational costs through automation of time-consuming patient and provider services (e.g., claims verifications and status, eligibility inquiries, provider lists). This self-service aspect has already gained limited, but growing, availability via payer-sponsored, patient-centric portals. These secure communication platforms supply online customer service, as well as information about disease prevention, wellness programs and other medical resources. Payers also benefit from reduced administrative errors, and improved speed and accuracy of healthcare claims transactions.

One question still looms in peoples’ minds: “Will this government supervisory role in healthcare be temporary or is it destined to become permanent?” Concerned constituents point to the founding of the NHIN as proof that government’s role is transforming from a single spoke of the healthcare wheel to that of the hub.

There is precedent to government, at its best, providing leadership to areas of public trust. Will healthcare benefit from this leadership? Only time will tell. Until then, it is incumbent to those of us in the industry to provide leadership and innovative solutions that enable the shared goals of providers to offer efficient, safe and quality patient care.

Andy Hurd is chairman and CEO of Scottsdale, Arizona-based Carefx Corp. He can be reached at [email protected].

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