Finding Common Ground

From the December 2004 Issue

By Ralph A. Korpman, M.D.

Ralph A. Korpman, M.D., is president and CEO of HealthTrio Inc., Nashville, Tenn., and a professor at Loma Linda University School of Medicine and the University of Tennessee.

The invitation was both unexpected and unusual. Would I come to the Capitol and have dinner with half a dozen health leaders in the Senate majority leader’s office? The attendee list was even more interesting, including Senators Bill Frist and Hillary Rodham Clinton, former Speaker Newt Gingrich and CMS Administrator Mark McClellan. How could I say no?

But to me, the most exciting part of the dinner was its purpose: This group of politically diverse individuals was coming together to understand what a new IT focus would do for healthcare, and to learn how quickly the benefits from such technology could be achieved.

As I walked into the majority leader’s office, I was struck by the realization that healthcare IT is, perhaps, the only health issue to garner this level of bipartisan support. While Republicans and Democrats may not agree on how healthcare should be financed or the effectiveness of the most recent Medicare reforms, they are becoming united in their support of some radical changes in the use of IT in today’s healthcare system. In fact, since President Bush announced his plan for all Americans to have an electronic health record over the next 10 years, newspapers and magazines have been full of editorials from this group of influential policy-makers, all well-crafted arguments supporting the same vision: a patient-centric model that facilitates patients’ involvement in their own care through the use of interactive electronic tools.

Patient-centric Records
This vision stems, in part, from the realization that when it comes to enhancing care and controlling costs, the only major untapped resources still available are patients themselves. For years, the healthcare delivery model was based on providers having the knowledge about patients and control of their care delivery. But there aren’t enough providers, and the numbers required to sustain this model can never be financed.

The new national imperative is based on the idea that the more that patients know about their own care, the better that care will be. Increased levels of patient participation not only present an opportunity to increase the efficiency, effectiveness and efficacy of healthcare, they also have the potential to fundamentally transform the way it is administered.

With this shift in mind-set, a more complex problem becomes clear: How does one do this? There are literally thousands of information systems in use today, but few can pull together a patient-centric record, which is clearly the most important view for a patient-driven healthcare system. Today’s systems are a result of the organization-centered design, deployment and acquisition approaches that have dominated electronic health record initiatives since they began. Representing only a portion of a patient’s overall health picture, these existing organization- or practice-centric systems focus appropriately on the needs of the enterprise, not the patient. But the time has come to service the patient’s needs as well.

A new model is emerging, one with a primary focus of allowing patients to become active participants in their own care. Called an individual health record (IHR), this patient-centric model fosters collaboration by allowing all participants in a patient’s care, including patients themselves, to access and enter information into an Internet-based health record that is centered around the patient, rather than around a care venue.

The IHR is created using patient healthcare data gathered from all available sources, most notably the claims stream, PBMs, pharmacies, laboratories and patients themselves. This level of consolidation produces a core patient record with a wealth of important information that enables the collaboration of all key stakeholders and empowers healthcare professionals with the clinical information they need to deliver the highest quality of care.

Structuring for Success
The successful IHR only works if it builds on top of existing technology infrastructures and does not require the installation of significant new hardware or software in legacy systems. The only successful possible user interface for this number of users is clearly a Web browser. Because browsers are ubiquitous and “rip and replace” strategies are avoided, properly designed IHRs can quickly deliver benefits to patients and providers by leveraging existing technology infrastructures and investments.

Patients own their record and control who will have access to it. Most patients choose to share this information with all their providers, but ultimately, patients are responsible for determining who is authorized to access their health information. In addition, audit trails further enhance the security of IHRs by maintaining a detailed record of who accesses the system, what information they access and when they access it. These audit trails are a key requirement for HIPAA compliance and help to ensure the secure exchange of patient information.

If one is to build a patient-centric IHR environment, who should maintain it on behalf of the patient? Any particular healthcare provider or organization is seldom responsible for all of a patient’s care. A not-atypical cancer patient may have 30 providers from different organizations over a two-year period. How does this information come together?

Enhanced Role for Health Plans
Looking at the stakeholders in the healthcare delivery system, it appears that the health plan may be the most logical organization to lead in the establishment of an IHR. Health plans are virtually the only place where all information relevant to a patient’s care comes together. While individual providers may have some of this information, they often have little knowledge about patient interactions with other providers and other parts of the healthcare system. But since everyone wishes to be paid, the health plan will almost certainly receive a claim or encounter report for every health interaction a patient might have.

Each claim or encounter contains vital diagnostic and procedural information that is valuable to all future caregivers. Health plans can pull claims data, along with information from pharmacies, PBMs, laboratories—all places where virtually all data is available already electronically, along with claims—and patient-entered information, to create a solid foundation for a complete IHR.

With more people jumping on the healthcare IT bandwagon, the IHR’s importance in improving care continues to increase. In an industry faced with the challenges of improving quality and reducing costs, IHRs present a unique and low-risk opportunity to enhance the health experience of each patient, regardless of the number of caregivers and systems involved in the delivery of care.

Unlike previous efforts that focused on building the best system for a hospital, practice or enterprise, the IHR model is conceptually more like a large number of individual health records, managed one individual at a time, than a giant system for the automation of everything. By consolidating core information from many systems with patient information, the chances of getting all providers and the patient working toward the same goal of optimizing care becomes achievable.

When properly executed, the IHR has been shown to simultaneously increase healthcare quality, lower costs, enhance stakeholder relations and improve the flow of healthcare information across the healthcare system—an end result on which everyone can agree, party affiliation notwithstanding.