● Healthcare Reform Beyond the EHR
Examining the next technology drivers in healthcare improvement. By Frank Ingari
ow that the Aff ordable Care Act of 2010 has been upheld by the United States Supreme Court, the healthcare industry as a whole must respond ag- gressively to comply with a host of technology mandates designed to enhance individual patient care, improve the health of general populations and reduce skyrocketing costs. T ese three goals constitute the “Triple Aim” of these mandates. T e implementation of electronic health record (EHR) systems is a massive fi rst step toward achieving these overarch- ing goals. However, it is only the fi rst step. Building on the EHR, three other technology implementation levels will be instrumental in making the Triple Aim a reality.
The role of the EHR as a technology platform
T e Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provided an initial impetus for technology adoption within healthcare. T is act contains specifi c directives for the deployment of EHR systems by medical facilities large and small, as well as physicians in private practice. However, EHR systems alone cannot solve the challenge of meeting the Triple Aim. Instead, they provide a critical foundation for the series of progressive technology moves the industry now must make. T ey off er a platform for the ad- ditional technologies needed to support multi-system integra- tion, clinical data informatics and the transmission of health information across local, regional and national exchanges. Each of these technology levels will play a key role in achieving the goals the industry laid out: Systems integration: To best maximize the deployment of an EHR system, healthcare organizations need a robust and scalable integration framework to create interoperability. Unfortunately, most EHR systems fall short in regard to strong integration capability. Although an EHR system may be ca- pable of transmitting data across a single enterprise, rigorous and robust application programming interfaces (APIs) are necessary to ensure communication with disparate entities. Right now, it is diffi cult to plug into the detailed user in-
20 January 2013
Frank Ingari is CEO of NaviNet.
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terfaces of EHRs, and software upgrades can easily wipe out any APIs developed. Consequently, healthcare organizations should plan to augment the EHR with complementary solu- tions capable of supporting diverse industry and technology standards.
Clinical and fi nancial data informatics: T e real-time
availability of patient information to medical providers, for example, enables evidence-based care, which can include everything from identifying targeted patients for outreach in a chronic care setting, to guiding medical interventions and alerting physicians to dangerous drug interactions. Financial informatics is just as important; without the integration of clinical and fi nancial informatics, risk-adjusted contracts cannot be created. Yet the policy-driven rules and engines necessary to achieve
this level of informatics are not present in EHR systems. Ob- taining useful data informatics requires a separate business intelligence solution that features the capacity to integrate tightly and securely with the EHR for the purposes of aggre- gating data generated by disparate systems. Information exchange networks: As growing numbers of
EHRs are deployed in tandem with informatics solutions to capture and analyze patient data, the need for networks that can instantly transmit patient health information has become more obvious. An advanced, HIPPA-compliant, standards- based nationwide network will enable providers across the clinical continuum to cooperate and collaborate to provide better patient care at lower cost. For such a network to come to fruition, the industry must
publish well-defi ned standards for the synchronization and exchange of data. An example of this is the Continuity of Care Document (CCD), based on the HL7 standard, which has greatly streamlined the transmission of patient data from one healthcare facility to another. T e introduction of integrated systems, informatics, health information exchanges and other high-tech solutions into the clinical environment will put healthcare organizations of all delivery models on the path to realizing the Triple Aim. HMT
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