Earlier this month I used a genetics anology to describe the amazing progress with electronic health record (EHR) usage by physicians over the past two years (see Progress being made to splice information technology into the healthcare industry's genome in Texas). Facilitating this progress are the EHR Incentive Program and other federal health IT initiatives that the Office of the National Coordinator for Health IT (ONC) oversees.
Last Thursday the National Coordinator of ONC, Dr. Farzad Mostashari, took my genetics analogy one step further in his keynote speech at the HIMSS12 Annual Conference for health IT in Las Vegas. And I have to admit that he improved upon it. I guess that's why he's in Washington D.C. and I'm not.
Dr. Mostashari warned the 36,000 conference attendees that along with this continued progress there are two other societal trends to align health IT with. He advocated for "twisting health IT to create a triple strand of DNA" with payment reform and patient empowerment.
Health IT, payment reform and patient empowerment. The triple strand of DNA to splice into the healthcare industry. I like that.
Payment reform is seriously needed to align incentives with the provision of quality care in an efficient manner. Right now I am basically paid to "encounter" patients and to do procedures. Although I am personally motivated to provide high quality care, the incentives are oddly there for physicians to "see more" and "do more" rather than to "see it done best". In addition, my documentation is based on meeting reimbursement rules to make sure I get paid rather than being based on communicating a clear picture of my findings and care plan. I absorb the extra time it takes to do both.
Consequently it is no surprise that for decades EHR vendors developed products based on episodic care. Physician's sought out products that would help them document and get paid for patient encounters. Documentation templates and charge capture functionalities were developed to maximize chances for reimbursement.
The potential for EHRs to improve quality and chronic disease management is just now starting to be realized. The ONC's health IT initiatives enacted by CMS under the HITECH portion of the 2009 Recovery Act are providing the push. But as payment reform proceeds, whether it be value-based purchasing, accountable care or some other program, EHR vendors will be incentivized even more to shift development efforts into chronic disease management and clinical decision support that are a basis for improving patient care.
And the third strand of DNA to splice into the healthcare industry, patient empowerment, is indeed an active and growing societal influence. But I will have to blog about that another day...