One of the key benefits of electronic health records (EHRs) is the ability to collect and analyze vast amounts of data with an eye toward improving performance reporting, chronic disease management and patient outcomes. Much of this information is in demand by specialty societies and associations to identify macro-level disease and treatment patterns. For example, a database (patient registry) that monitors joint replacements can offer insight into which brands of artificial joints perform most effectively.
Unfortunately, the way EHR systems are implemented and managed make it difficult for healthcare providers to share EHR data with external organizations, including registries, according to a recent Politico article. Other vendors charge additional fees or try to sell their own proprietary integration software. Some vendors have gone as far as to issue cease-and-desist orders to their healthcare provider-clients who are running registry software. The net result is data blocking, which limits the amount of healthcare data that flows to patient registries. Without complete data, registries do not have a 360-degree view of patient medical records. The impact of this can be felt across three key areas:
- Performance reporting
Medicare and Medicaid incentive programs for achieving patient and practice improvements under value-based care initiatives require a new approach to measuring success – and receiving full reimbursement based on improved patient outcomes. These incentive programs, including Medicare Access, the CHIP Reauthorization Act of 2015 (MACRA) and other bundled payment programs, call for free flow of data between healthcare providers and public health information exchanges (HIEs). If registries, which are intended to derive insights and improved outcomes, are unable to collect good quality data, it will inhibit physicians from reporting the data required to receive reimbursement. This will have a particular impact on providers responsible for reporting patient data to the government when MACRA legislation takes effect in 2017. The Centers for Medicare and Medicaid Services (CMS) projects a 94.7 percent adoption rate for required data reporting among physicians in 2017, up from 62.2 percent early adoption in 2014, as phased penalty programs begin to threaten physician reimbursement.
- Chronic care management
Managing chronic care (diabetes, high blood pressure, COPD, asthma, etc.) is one of the biggest challenges in healthcare today and will continue to be for the next 25-50 years. Identifying at-risk patients and providing intervention and support services are key to lowering healthcare costs, closing care gaps and increasing patient compliance with medication regimens. All of those activities rely heavily on collecting massive amounts of patient data to track trends that may lead to changes in the way chronic illnesses are treated and managed. But to accomplish this, healthcare organizations—all with disparate systems and varying data formats—must find a way to aggregate and share data.
- Patient outcome improvement
The true value of a registry lies in having access to an evidence-based approach to improving patient outcomes. Many in healthcare believe that cures for some of the most common and chronic diseases already reside within existing and available data. Identification of practice patterns and other factors can produce higher-quality outcomes with greater efficiency. Registries have enormous potential for “improving the safety and quality of therapies and medical devices,” the Politico article argues. For example, the Food and Drug Administration’s (FDA) planned evaluation system for health technology “would rely in large part on specialty society registries,” particularly for approving medical devices. Data blocking could skew the sample of devices that the FDA evaluates.
It’s a Matter of Purpose, Not Competition or Technology
The technology to share EHRs and other healthcare data is available and accessible. There are robust registry structures and interoperability solutions available, including Liaison Technologies’ ALLOY™ Health product suite. However, data blocking by EHR vendors threatens to interfere with the ability to share data across all organizations.
It’s important to understand that data blocking isn’t a competitive issue. EHRs and registries serve different purposes. EHRs are the system of patient record and drive accurate treatment and billing. Registries need to use EHR data as one of the sources of data that specialty societies and research organizations can use to improve healthcare. Registries are for advancing medicine not treating patients.
Yet EHR vendor-initiated data blocking persists. The federal Office for the National Coordinator for Health IT (ONC) reported in 2015 that only 38 percent of hospitals reported using or integrating patient summary care of records from sources outside their health system – a drop from 40 percent in 2014. And 25 percent indicated that additional costs to exchange data with outside providers or settings were a barrier to health data exchange.
We hear about this issue from our customers too frequently. The healthcare industry must encourage and work with EHR vendors to make ubiquitous data sharing core to their solution and included as part of their ongoing fees. The stakes are too high to do otherwise.
I would love to hear your feedback,
Danielle Siniscalchi, Liaison Technologies Sr. Director, Registry Solutions