Many in health care nowadays are aggressively looking to reduce costs while also improving quality. How crucial of a role will health information technology play in the drive toward those two aspects of the Triple Aim, and can forces align in the industry to help it do so?
Such questions, of course, were a big topics of conversation at last week's HIMSS conference and something I recently talked about with Michael Zaroukian, M.D., chief medical information officer with Sparrow Health System, and one of the opening keynote speakers. Sparrow, a four-hospital network out of Lansing, Mich., is a HIMSS Stage 7 organization, meaning it's essentially a paperless hospital that can share information freely among hundreds of other health care organizations.
Zaroukian — also a professor of medicine at Michigan State University and one-time panelist at the White House to discuss the advancement of his field — believes that HIT will prove vital in understanding the field's success in improving care and lowering costs.
"It's absolutely essential to that task," he says. "The problem is, of course, that we are still fairly early in the use of health information technology to improve care and, because we have not standardized around one or even a number of particular workflows or cognitive support tools, it's harder. We're finding our way through that process, a natural growing pain for such a big effort in a short time in an industry that has been behind others with regard to the use of information technology to improve quality, cost and efficiency."
The barriers to using HIT to drive toward value are numerous yet surmountable, Zaroukian believes. Those include, of course, the lack of interoperability between disparate systems. Integrating such technology into a doctor's everyday workflow is also an ongoing struggle — "taking these tools that providers and other staff are trying to use to deliver care and organizing them in a way that's highly usable." Electronic health records are also overly geared toward billing and not clinical care, making doctors' jobs harder than necessary.
"The good news going forward is that there are forces, policy levers that are used nationally to help move from volume to value so, rather than the number of patients who are seen and the totality of the documentation that's being created, the outcomes that matter are going to increasingly influence the payment for care," he says. "That will help move us further along in the direction that both providers and patients and communities would like to see, but even that is somewhat uncharted territory. There are some demonstration projects showing how you can move to accountable care and shared savings programs, but it's pretty new, and using technology to support that is a work in progress."
Do other policy levers need to be pulled outside of the meaningful use program? Zaroukian believes that, as the health care system continues to drive toward value, hospitals and health systems will need data on performance, patient conditions, and what is and isn't working, along with a mechanism to assess and improve quality on an ongoing basis. Policy going forward should focus less on specific technology and more on outcomes, he believes.
"The policy direction will reflect that combination of payments that physicians and other health professionals see as part of quality, safety and value. At the same time, they will be incremental in their approach so that the kinds of changes needed to pay physicians and others for value are feasible within the current information technology infrastructure."