It seems like just yesterday the healthcare industry was on its feet applauding our arrival into the “future” with the introduction of regional electronic health records (EHRs) and Health Information Exchanges (HIEs). With EHRs/HIEs, came “continuity of care”, “integration” and “interoperability”. In most cases, EHRs/HIEs implementations have successfully established a solid foundation for the ultimate goal: a complete longitudinal patient record for all patients, across all care-settings. But we have since learned that there are still much more to consider before we can achieve this ultimate longitudinal goal.
There are several approaches to establishing the ultimate longitudinal patient record. But which approach will have the greatest impact on patient health? Which will achieve better financial outcomes? Three strategies are emerging.
- Expand the Longitudinal Patient Record
Many health jurisdictions are focused on consolidating their existing investment in HIEs/EHRs by increasing the number of data types and care settings captured, in addition to increasing user adoption. This is an inexpensive way to expand the longitudinal record while achieving step-wise improvement in clinical and financial outcomes. For example, Alberta Netcare EHR now captures discrete data across thousands of clinical care-settings and is accessed by over 5,000 concurrent users with approximately 50,000 active clinical users across the province. Monthly Netcare access is in excess of 5.5 million portal screens viewed, containing information from 1.9 million unique patients. There may be even bigger financial and clinical outcomes in the near future as the breadth and dimensions of available patient data grows. Many healthcare providers in the U.S. are now exploring precision medicine, backed by President Barack Obama’s investment into customising patient treatment via his announcement of the new Precision Medicine Initiative.
- Enable Clinical Processes across Disparate Care Settings
Although simply viewing a patient’s most recent EHR/HIE data can be very valuable to providers in their assessment of patients, many jurisdictions have found that clinical workflow and processes that bridge across multiple care organisations are much better suited for leveraging regional data in EHRs/HIEs. This has become especially true when compared to more traditional solutions such as Electronic Medical Records. In one case, the Ontario Ministry of Health and Long-Term Care leveraged its existing investment in province-wide patient data to implement community care assessments, and more recently, the Ministry also implemented care coordination and patient care plans that span across multiple care settings throughout the province. In Alberta, eReferral has been implemented as an integrated application of the very successful Netcare EHR, enabling the seamless delivery of referrals across community and specialists care settings in the province. Both in the Canadian and American health systems, outcome-based-funding will continue to drive the need for population health management and the coordination across care settings.
There is a strong business case for ‘bridging’ clinical processes. Complex patients that span multiple care settings account for up to 80% of the cost in many jurisdictions. Solutions that reduce waste, duplication, and isotropic events across disparate care settings can significantly improve financial and clinical outcomes. For example, Ontario has determined that a 10% reduction of costs in these areas could result in $1.5 to $2 billion in savings annually.
- Include Social Determinants of Health
Chronic disease accounts for 86% of all medical costs in the U.S. according to the Centres for Disease Control and Prevention. Not all, but most chronic diseases are caused by lifestyle choices, the environment we expose our bodies to, and other factors outside of health care. Some analysts point out that healthcare is often trying to solve a social science problem with expensive medical solutions that only treat symptoms, not the causes.
Some jurisdictions are now incorporating information and new processes into their EHRs/HIEs which, until recently, was not viewed as part of the “healthcare” domain. The University of Wisconsin Population Health Institute annual survey consistently identifies that only 20% of person’s health outcome will be determined by access to quality healthcare. Lifestyle choices and socioeconomic factors together have over a 70% influence in determining a person’s health outcomes, and to a very large extent the success of a patient’s care plan.
Managing these social determinants of health can have the biggest impact to the effectiveness of a patient’s care plan, and can result in significant improvement in clinical and financial outcomes. The Ontario Ministry of Health and Long-Term Care is one of the first Canadian jurisdictions in the process of implementing coordinated patient care plans that include – in addition to the typical medical information – physical, mental, social, situation and lifestyle information into a patient’s care plan.
In most cases, EHRs/HIEs implementations have successfully established a solid foundation for the ultimate goal: a complete longitudinal patient record for all patients, across all care-settings. Successful healthcare jurisdictions will leverage a combination of strategies to focus their efforts beyond creating foundational infrastructure, to having a bigger impact on patient health.