EHRs not sufficient for data liquidity

Until recently, efforts to integrate health IT have focused on increasing acquisition and adoption of EHRs. The current industry focus, however, is on the development of consensus-based guidelines on the "meaningful use" of EHRs to qualify for the federal incentive payments.

Meaningful use includes promoting patients' access to their own clinical information, improving the exchange of health information among providers and care teams to support care coordination, and providing better information for joint consumer-clinician decision-making at the point of care.

EHRs are necessary components for these activities, and they are not sufficient alone to drive the type of change in healthcare delivery required to realize the quality improvements and cost savings that are necessary for real system reform. An EHR is one specific technology within the health IT portfolio, which also includes e-prescribing, clinical decision support, messaging and alerting, telehealth, consumer health information portals and other technologies. Adoption of EHRs addresses one goal: getting paper out of the healthcare system. And it does not go far enough to get electronic information about patients to their health professionals at the point of care in real time.

1. EHRs are necessary but not sufficient for data "liquidity." The experience with e-prescribing has demonstrated that there is independent value to removing paper from a single process-prescribing drugs. The efficiencies reduce error rates, reduce prescription fill times and produce cost savings. There are many technologies that will assist in streamlining and improving the patient-centeredness of our complex healthcare system. Some of these technologies, particularly those that allow patients access to their information, are yet to be developed.

2. The market is not demanding robust EHRs, as shown by low adoption rates, especially in small office-based practice settings. As we increase the supply of certified EHRs, we also need to remember that EHRs are still evolving. Financial incentives are useful and necessary, but the best driver of adoption will be demonstration of value to the consumer and the provider.

3. Even with widespread adoption of interoperable EHRs, we still need to address other gaps and barriers to reach the vision of full interoperability. As the recent definitions of "meaningful use" acknowledge, making information electronic does not mean it will be automatically shared outside of the organizational or network firewalls, or across organizational boundaries, because of technical, legal and privacy concerns and because of competitive concerns in the private market. Federal, state, payer and consumer groups must consistently demand interoperability and take steps to make data exchange accepted and possible.

Free-flowing health information, communication among care teams, and all of the inherent benefits of interoperable health information do not come automatically with EHR adoption-and in fact, some benefits of interoperable health information can be realized without EHRs. Therefore, it is critical to focus sustained energy on other components that must be addressed to achieve benefits and derive value from liquid health information.

Two accelerators combine policy and market changes to change healthcare delivery and promote interoperability as a way to improve the flow of health information.

First, the healthcare industry should focus on enhancing the flow of health information and communications among patients and providers, with clear goals around interoperability. Focus additional energy to eliminate inefficiencies in paper-based medical practices in critical areas, such as prescriptions, lab results, and medical imaging data. All three sources of information are of high value and should be available in electronic form at the point of care in real time.

Further, payment reform is also needed to move toward a patient-centered system. For example, the fee-for-service payment system does not currently pay for coordination of care. This approach is out of alignment with the nation's goals for safe, timely, efficient, effective, equitable, and patient-centered care. Significant reforms to public and private payment can help remove counter-incentives and conflicts from competitors in the healthcare system while encouraging the appropriate technology investments required to make health information flow.

In addition, a common understanding of health information applications and shared services needs to be outlined and developed. Multiple regional health information organizations and health information exchanges have identified, and in some cases overcome, the challenges of information exchange and governance. The information architecture can provide a common understanding of how health information applications and shared services can work together to create an affordable, high-functioning, and secure information transfer platform.

Standards-based information exchange protocols are required so multiple stakeholders can share information using various health IT applications. The certification process could focus on the ability of health IT to meet interoperability requirements, regardless of the form their product and services may take. Also, the nation could support a comprehensive standards-based network for e-prescribing and decision support that encompasses all prescription drugs and includes controlled substances. If existing policies and standards at the Department of Health and Human Services (HHS) and the Drug Enforcement Administration (DEA) were harmonized, an affordable, phased-in, clinician-driven e-prescribing system could be fast-tracked, opening up the flow of e-health information.