In April, the ONC released an update on health information exchange. It reported that about 75 percent of US non-federal acute care hospitals were exchanging data with outside providers (for example, non-affiliated practices or other hospitals). That’s a sea change compared to 2008, when only about 40 percent of hospitals were exchanging data with outside providers.
That growth — an 85 percent increase — isn’t confined to any particular region of the country. The ONC notes that in 2008, only 10 states had a clear majority (60 percent) of hospitals electronically exchanging key clinical data with outside providers. In 2014, 47 states (all but Idaho, Nevada and Mississippi) and the District of Columbia reported that at least 60 percent of their hospitals were exchanging key clinical data.
If, as network theory asserts, the value of a system is enhanced as more nodes are added, this bodes well for the nation’s healthcare system – and indeed, for patients. Because let’s face it, the point of federal incentives for data exchange (and penalties for failing) should never have been about simple data exchange, but rather the value that exchange can provide for physicians and patients alike. That’s why it’s called “Meaningful Use” and not “Mere Use.”
“What’s the value and the use of exchanging data?” asks Leslie Krigstein, interim Vice President of Public Policy of the College of Healthcare Information Management Executives (CHIME). “Just because you are exchanging data, you are not necessarily improving care. We need to talk more about the value to healthcare delivery.”
One response to Krigstein’s question might be found in two of the more contentious requirements proposed for Stage 3 of Meaningful Use. According to the MU Stage 3 rules proposed this spring, hospitals and practices hoping to qualify for incentives will need to provide EHR access to 80 percent of their patients, and access to patient-specific educational resources to 35 percent of their patients.
Furthermore, there are three measures of active patient engagement: Twenty-five percent of patients must access their records through specified electronic means; thirty-five percent of patients must receive a clinically relevant secure message; and providers must incorporate information from patients or "non-clinical" settings for 15 percent of patients (i.e. home health, physical therapy or perhaps wearable devices).
These are contentious requirements for many reasons – should patients be able to enter data into an EHR? Even if they should, will they? And if the federal government wants patients to actively engage with electronic health records, shouldn’t incentives and penalties be aimed at them and not the providers?
Let me flip network theory for a moment: Within an increasingly interconnected healthcare system, the value of patient engagement is significantly enhanced. It’s a blessing, not a curse.
As Krigstein told me, one driver of needed change is “a new level of understanding among patients that their data should be fluid.” And new payment models mean that it’s not just hospitals that should be exchanging data, but it should occur “up and down the continuum of care.”
In other words, MU Stage 3 doesn’t envision a world where patients routinely enter data to populate their records, or routinely pull down a copy of their EHR to print out and study. Instead, it contemplates the capacity for devices, labs and a host of providers to continuously update a fuller data representation of the patient’s current health.
That representation, in detailed form, might enable physicians to make more accurate diagnoses, for example, or to identify a public health threat in its earliest stages. Meanwhile, in dashboard form, the representation could help patients make better choices about their daily diet, exercise and wellness activities. After all, “better-informed” doesn’t mean “crushed by data.”
Most promising of all, such a representation — however presented — should enhance the patient-physician relationship, providing a new level of transparency. In medicine, ignorance is not bliss; better-informed physicians and patients will be close collaborators in the quest for healthier lives.
What questions do you have?