DOCtalk by Dr. Gregg 3/31/14

HIT’s Next Big Role

MU has done its duty. Providers are adopting EHRs.

Patient charts are no longer merely a massive collection of indecipherable scribbles within mountains of paper. Great. Providers are digitizing. Great. Healthcare data is becoming mineable. Great. But what movement in the outcomes needle has been driven?

Notes in legible digital format are of little more value than paper records if EHR X can’t share digitally equivalent data with EMR Y. Digital data is worthless without aggregation, analytics, and evaluative proceedings.

Thank goodness HIEs are starting to connect, even though mostly with hospitals thus far. But, we are finally starting to see signs of data sharing, and buzz terms like “data analytics” and “big data” are replacing “meaningful use” and “interoperability.”

As a whole, EHRs may not be beautiful, nor fully functionally friendly, but that’s mainly an issue of refinement. As a whole, our collected data isn’t very well connected, but that’s a “yet” thing; it’s happening. Data input and capture, data sharing, and data analytics are important – nay, vital – to changing healthcare, to be sure. Most of these are on a roll, and there are some up-and-comers in process to take this data and its analyses to exciting new heights. The challenges of grabbing and scrutinizing data are becoming overcome.

Well then, now that we’re seeing reports of some 60% or so of providers gathering data digitally, and now that HIEs are starting to show signs of respectable life beyond the mostly (or wholly) defunct RHIOs and CHINs, the question becomes: what’s the next big step for HIT? If changing healthcare is all about improving outcomes – and who can argue that good outcomes should always be the goal for healthcare? – will digitized data and its analyses be enough to drive us to, and through, that hoop? (Can you tell I’ve been catching some March Madness?!) Will better measurements yield better results?

Maybe. Some, anyway. I’m a huge fan of smart data used smartly. However, we’re talking about human beings here, not just manipulable metamessages and figurable facts.

People are full of subtext, subplots, and subtly subversive subterfuge, especially when it comes to lifestyle choices, and healthy – or non-healthy – behaviors. We all have our daily rationalizations and self-interest self-deceptions. We say we want one thing, but proceed to act in complete contraindication to that end.

HIT’s next big challenge will be more about the marketing to, and motivation of, the men and women of healthcare, both in front of and behind its delivery. How do we persuade human beings to change their health habits, and healthcare delivery habits, given the inherent difficulties of being human?

How will the 40% of providers not yet on EHRs become driven to adopt? Obviously, the MU carrot-stick thing hasn’t been enough.

How will we motivate independent or non-institutional providers to connect to HIEs? There won’t be any more MU-esque goodwill monies flowing from the feds.

How will providers be motivated to continue to collect data? It seems inefficient to think that “prizes” and “beatings” (i.e., carrots and sticks) will suffice to keep the data collectors feeding the data miners.

How will providers be inspired to change communication habits (with other providers and with patients) and alter longstanding workflow patterns to capitalize on the new values that connected HIT can bring? Change is hard, even if it’s good change; changing habits is even harder.

Lastly, how will Jane and Joe Sixpack become aware of the advantages of connected data and motivated to both gather and share it? Beyond the tech-heads, fitness-buffs, early adopters, and fad-focused, there’s a whole wall of folks that will need inspiration before the full-bore, major-shift, healthcare-change tipping point is reached.

This challenge – the inspiration of consumers – may just be the key to all the rest. If HIT can motivate and massage consumers to become fully actualized healthcare participants on a grand scale, their participation will spur the remaining provider change.

Providers are inspired by need; they respond to it. That’s what got most healthcare folks into the field in the first place. If consumers of health services display or voice a specific need to their healthcare providers, their providers respond. That’s what they (we) do.

Here’s where HIT has its next big role. We must develop more user-friendly patient portals, portals that are less one-way, more interactive, and which become integral to the consumers’ thought processes for healthcare information and communications. We must tie these portals to the nascent but burgeoning world of wearable tech and smart phone tools that measure body metrics and provide insights into behavior patterns. Then, we must bring HIT analytics into the mix to enable a massive shift in personal health data that can be aggregated and utilized for both provider scrutiny and patient empowerment. And, it’s imperative that dashboards presenting this info be made human eyes-friendly.

Consumers need a new, friendly, non-intimidating healthcare face. They have had enough of the world of medicine’s non-transparency and egoism. They want to understand health issues without obtaining a degree in medical terminology. The whole patient empowerment movement arose from such needs.

If HIT steps up to help fill that order, consumers will find unprecedented empowerment. When they do, they will begin to spur their providers with new needs to which the providers must, by training and by inclination, respond. If healthcare consumers start expecting easier, more understandable access to healthcare data, if they begin to demand simpler communications via IT, if we all share with our healthcare providers the need to empower us as partners, not paternalized patients, then providers will respond. As I said: that’s what providers do.

The unadopted providers will adopt or die. The unconnected will connect or fail. The old style communicators will learn new methods or face extinction.

HIT can motivate change in consumers that will drive transformation in providers. That’s its next big role. When the men and women both behind and in front of healthcare delivery are playing together in a friendlier and more equitable sandbox, well, that’s when the outcomes needle starts its shift.

From the trenches…

“Step with care and great tact, and remember that Life’s a Great Balancing Act.” – Dr. Seuss

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).