The election is behind us and the country has chosen a course for the next four years. Irrespective of your political views, it's a fitting time to look back on all that we've collectively accomplished in the last four years when it comes to using healthcare IT to improve outcomes and reduce costs. We have a lot to celebrate as we think about what the future holds for our healthcare reform journey. The list of achievements is impressive and demonstrates the traction we can gain when the public and private sector work together toward a single goal. While there is still considerable work to be done, we have created a powerful springboard for accelerating progress and expanding impact in the years ahead. Our progress includes many positive steps.
1. The Health Information Technology for Economic & Clinical Health (HITECH) Act jumpstarts health IT adoption. The act, which provides doctors, healthcare professionals, and hospitals with Medicare and Medicaid incentive payments when they adopt and meaningfully use certified electronic health record (EHR) technology, has provided much-needed fuel to jumpstart EHR adoption. Depending on the survey, EHR adoption now spans between 57 percent and 74 percent of physician groups.1 Regardless of the discrepancy in methodologies, all trends point toward greatly expanded adoption. The Centers for Medicare and Medicaid Services (CMS) just reported2 that Medicare and Medicaid electronic health record payments have surpassed $8 billion since the act's inception, with $8.36 billion paid out to 165,800 eligible physicians and hospitals in total program estimates through the end of October 2012. While there has been considerable debate around the process of defining meaningful use, make no mistake that those two words have sent a clear message – having the technology is not enough, what you do with the technology is what really matters. While technology adoption is step one, the long-term goal is better coordination of patient care, reduced medical errors, elimination of duplicate screenings and tests and the costs associated with them, and greater patient involvement. The healthcare system is better because of HITECH and the path it has set for the United States.
2. The Office of the National Coordinator of Health IT (ONC) sets a clear agenda and direction. Under the direction of Farzad Mostashari, M.D., the ONC has played an instrumental role in accelerating health IT adoption and impact. In addition to presiding over the EHR meaningful use incentive program and its rapid adoption, ONC has launched standardized secure messaging under the federally sponsored Direct Project, released the National Quality Strategy, created regional extension centers, launched programs to train new health IT workers, strengthened security provisions and increased focus on consumer e-health. From personal experience, I can tell you that the team at ONC is engaged, focused and passionate about their mission to improve healthcare in the US through health information technology (HIT). Regardless of your political affiliation or bias, we should all give ONC credit for the incredible transformation they are seeking to bring to our system each day. They are open to new ideas, transparent in their thinking, and true enablers of change. HITECH was the catalyst to bring ONC into a formal organization under the Department of Health and Human Services (HHS), and for that, we should celebrate all they have accomplished. I’m proud of ONC and their vision albeit imperfect.
3. The Nationwide Health Information Network (NwHIN) is set to gain traction. The ONC had been facilitating development of the NwHIN, which will tie together health information exchanges, integrated delivery networks, pharmacies, government, labs, providers, payers, and other stakeholders into a 'network of networks.' As of early 2012,3 what is now called the eHealth Exchange included 34 participants that represented about 500 hospitals and 3,000 providers. In response to public comment, the ONC decided this summer to transfer governance of the NwHIN to Healtheway Inc., a new public-private, not-for-profit organization. With the spread of EHR adoption and the increasing ability of physicians to retrieve data from health information exchanges (HIEs), as well as the interoperability criteria of Meaningful Use Stage 2, which will require providers to exchange more information with each other, the number of providers exchanging information or about to go into production must now be higher. Putting the project in the hands of both public and private partners, which was completed last month, is a tremendous step forward.
4. Accountable care begins to take hold. With the Supreme Court ruling on the constitutionality of the Affordable Care Act (ACA) last spring, accountable care organizations (ACOs) ‒ whether as defined in the ACA or more generically defined as a model of payment based on providers being held accountable for outcomes ‒ are set to expand and play an important role in helping healthcare organizations to drive down costs while improving outcomes. As of July 2012, ACOs were serving 2.4 million patients4 in 40 states and the District of Columbia. We can expect to see this number expand rapidly in the years ahead along with ACOs' contribution to improving care coordination and outcomes while reducing costs. There is still work to do in defining how we measure outcomes longitudinally across sites of care but without question, viewing a person’s health or condition as a journey versus a healthcare event is critical to the transformation of our system so that we focus on preventing sickness instead of fixing acute health problems.
These important milestones provide healthcare IT with a solid foundation to guide us into the next four years. However, progress will not come without challenges. As more and more hospitals lay the groundwork for their EHR systems and participate in HIEs, the resulting explosion of data will become a major road block for the underprepared. Analytical applications are readily available to assist organizations in managing and understanding this data, but to truly improve care, a comprehensive approach is required. The vision of healthcare 'without walls,' where a connected healthcare delivery platform will be supported by greater use of patient-controlled data, the leveraging of health data through analytics, and empowered patient and physician communities, provides the greatest opportunities for the future. The adoption of disruptive technologies – such as remote monitoring and mHealth technologies – will also move treatment and patient management beyond the confines of the traditional institution.
Four years from now I envision highlighting the great collaboration and innovation our country has put forth to develop more efficient systems that focus on preventive care and longitudinal disease management. To get there, we need to ride the momentum these recent accomplishments have provided us with and refocus on the vision of what can be versus what is imperfect today. The focus on HIEs, EHRs, and ACAs is powerful, and the U.S. is well on its way to becoming a global leader in HIT. Our role as healthcare professionals is to lead change within our country, and globally, so that together we can make healthcare safer, more predictive, and a system of wellness. Are you ready to leave a legacy in your career? This is our chance and I’d like to hear your thoughts on how we can deliver on this promise we have made to future generations.
Marc Perlman is the global vice president of healthcare and life sciences for Oracle Healthcare.
1. "EHR Adoption Grows As Docs Bid For Incentives," InformationWeek Healthcare, August 29, 2012.
2. "Medicare, Medicaid EHR meaningful use payments surpass $8B in October," Government Health IT, November, 9, 2012.
3. "Feds Complete Transfer Of National Data Exchange Operations," InformationWeek Healthcare, October 8, 2012.
4. "HHS Announces 88 New Accountable Care Organizations," Centers for Medicare & Medicaid Services, July 9, 2012.