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In other words, care models are important, but it is really the medical providers embracing these models and sharing the total care of the patient that will help us achieve the improved health outcomes.

Bridging the gap Without EHRs and HIEs, it has been diffi cult for provid- ers to develop genuinely collaborative communities of care. As a result, healthcare has grown essentially as a cottage industry, with individual providers using their own chosen methods to tend to their own unique patients.

Charles W. Jarvis is VP of healthcare services and government relations for NextGen Healthcare Information Systems. For more information on NextGen Healthcare Information Systems solutions:

It is this element of indi- viduality that makes nation- wide HIT interoperability more diffi cult to achieve than the interstate highway sys- tem. Indeed, the healthcare reform envisioned by the PCMH and ACO models

requires much more than simple data interoperability; it re- quires a commitment to collective healthcare responsibility. “Accountability” is the operative word in collaborative care models, and it starts with patient and medical provider.

So how do we bridge the gap? The fi rst step involves the industry’s willingness to pledge adherence to a uniform set of data standards. While standardization is not absolutely necessary – just as inter- state highways are not absolutely necessary for automobile travel – it nevertheless is essential to building the greatest degree of effi ciency into any model of care. In addition to effi ciency, standardization also allows independent third parties to offer compliance certifi ca- tion. Certifi cation is a powerful tool to help organizations know whether a given EHR system provides the kind of standards-based data exchange necessary to achieve interoperability (the ability of disparate systems to talk to one another) in these collaborative care models. Once you connect certifi ed EHRs under one HIE, you establish the beginning of information fl ow to create true, community- driven healthcare.

The next step is for providers to accept data about patient care that comes from another trusted medical provider in the community, which the original provider may not have had any part in developing. The third step is the compliant patient taking responsibility for his health. He must change his behaviors or maintain a discipline of living that allows him to play a major role in controlling his own healthcare outcomes.

Attaining accountability Make no mistake: Leveraging technology to go beyond basic data interoperability and actually enhance patient

care will not be easy. It requires everyone to make changes, from patient to provider, facility to payer. In order to lower costs and improve the quality of care, the current focus on acute, episodic treatments must be replaced with community-directed, population-based therapy. Rather than simply reacting to individual illnesses as they present, providers must be encouraged to use data analysis and “best practices” to spur better preventive measures. Public health initiatives, wellness campaigns, patient education and even healthcare “peer pressure” must be employed to raise the standards of care. Three factors are integral to success: 1. Patients must be invested in, and take responsibility for, their own healthcare;

2. Care must be coordinated for maximum effi ciency by those providers in the best position to engage in highly personal patient/provider relationships (e.g., primary care physicians); and

3. Reimbursement must be restructured in such a way that preventive care is rewarded rather than discouraged. Overcoming the fi nal factor – restructuring reimburse- ment methodologies – poses the most widely debated challenge with regard to bringing collaborative models of care to fruition. Yet it is only the penultimate challenge. The ultimate challenge is getting the patient to accept the consequences of his healthy or unhealthy lifestyle. True healthcare reform and accountable care are much bigger and broader than the physician/patient relationship and the technology that comes with these care models. They entail a reform of society itself, bringing it to a point that applauds healthful choices instead of potentially harmful ones.

Sharing patient information between specialties within the healthcare community is the start of more integrated care. From there, sharing patient data among larger enti- ties – geographic regions and payers, for instance – will help gather more accurate data for the formation of “best practices.” This is how data uniformity begins to shape the meaningful use of HIT.

HIT then can begin to help providers work toward improving overall population outcomes, as opposed to solving episodic patient problems. Right now, for instance, a physician might measure how long it takes for patients to receive an appropriate prescription. But that is only a measurement of the healthcare process – it is not a mea- surement of patient outcomes. Providers should be asking: “Is my patient healthier, hap- pier and better off due to my interventions?” And patients should be asking: “Am I taking appropriate responsibility for my health and not relying on medicine to make up for my unhealthy behavior?” When the answers to both of those questions are yes, we will be well on the way to creating a healthier society and not one that simply consumes scarce healthcare resources.


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