Pursuing a career in health care was inspired largely by my family – whether they know it or not. My father was a biochemist and neuroscientist, my mother a dietitian and health care researcher, a sister is a physical therapist, and a cousin is a pharmacist. My path in health care has been different from theirs, with an emphasis on health care strategy, innovative business and program development, and executive leadership of both non-profit and for-profit companies.
In my experience, one of the biggest challenges in improving the performance of our health care system is to reduce the wide and inexplicable variations in how health care is delivered and the resulting disparities in cost and quality outcomes. At National eHealth Collaborative (NeHC), we hope to help the health care community to leverage health IT, health information exchange and sharing of best practices to make significant progress in this direction. This is of paramount importance when we envision our loved ones or ourselves afflicted with a serious illness and subject to potentially unpredictable and uncoordinated care.
No one is more vulnerable than when they hear a dreaded diagnosis or when they find themselves in a hospital gown. Who among us does not have stories of miraculous treatments, even cures, that can be achieved and what has gone horribly wrong and resulted in tragedy? That in itself shows the wide variation in our experiences with the health care system.
Let’s take a breast cancer diagnosis for example. I have had multiple close friends and family experience this in recent years. While the overall process may follow a similar pattern, the details of what and how information is communicated, what options are discussed with the patient and how; what level of coordination and information sharing there is among providers and with the patient’s caregivers, or if the patient is responsible for gathering and transporting their medical records from provider to provider; whether there is shared decision making between provider and patient or the patient is advised of a single recommended course of action; to what extent patients are aided with nutrition, physical therapy and other critical needs…. The list of questions and variations goes on and on. How much of this variation is clinically warranted or based on evidence? How much depends on provider or patient communication style, practice or geographic culture, provider or payment incentive structure, or access to electronic health records, clinical decision support and electronic health information exchange? Some of this variation is likely justified; however, best practice sharing and acceptance of evidence based clinical protocols supported by widespread use of health IT, including electronic health records (EHRs) and health information exchange, will consistently improve the entire patient experience and result in better quality and value outcomes.
Health IT is an important tool to support improvements in our health care system. EHRs with clinical decision support are a necessary foundation to improve the effectiveness, efficiency and coordination of care and to reduce unnecessary variation in treatment and outcomes. Health information exchange ensures that the patient’s information follows them wherever and whenever needed and enables coordination of care among multiple providers. The Health Information Technology for Economic and Clinical Health (HITECH) Act – a stimulus fund that invested $19 billion in the implementation and growth of health IT – has been a powerful catalyst in driving adoption and use of EHRs, and in encouraging health information exchange and patient engagement. There has been an enormous amount of progress in the right direction in recent years and HITECH has contributed significantly to that progress.
Given the level of Federal government investment in HITECH, it is appropriate to expect Congress and the public to raise questions, be critical and scrutinize the results. Questions have been raised about the return on investment in health IT and the impact it has had on cost savings and quality improvement, and those questions must be answered.
However, it is important to remember that progress takes time and transformation of an industry takes even longer. Health IT is a very important tool and implementing it is just the first step. Integrating health IT into practice workflow to drive better care and better results is another thing entirely. Health care transformation requires culture change among providers and patients alike. Furthermore, even with all the health IT tools we need in place, we will not achieve the results we need unless or until we have payment reform to align incentives among payers, providers, patients, and other healthcare stakeholders such that we pay for value rather than volume. Again, important progress is being made by the Centers for Medicare and Medicaid Services and its Pioneer program and other models moving toward accountable care. Private payers have also been leading the way in testing different payment models and supporting providers with technology and analytic tools.
Hopefully the pace of change will continue to accelerate, improvements will be achieved and those successes will spread. This should benefit our loved ones and ourselves when we need it most. I also hope that National eHealth Collaborative can play a small part in this transformation by serving as a convener of stature to tackle tough health IT issues and supporting the health care community by providing concrete tools to deploy health IT successfully, especially with health information exchange, patient engagement in eHealth, and health IT education programs.
- – - – -
Kate Berry is the Chief Executive Officer of National eHealth Collaborative (NeHC), a public-private partnership that works with its partners, including the Office of the National Coordinator for Health IT (ONC) in the U.S. Department of Health and Human Services (HHS), to engage stakeholders in a collaborative way to realize common goals that lead to transformative change. She has more than 20 years of healthcare experience, and is a nationally known expert on electronic prescribing and a sought after speaker on related topics.