Aaron Berdofe, MHI – Health Informatics

Last at at NBC’s Commander in Chief Forum, HIT made a brief and fleeting appearance in a response by Hillary Clinton to a question relating to veterans’ satisfaction with the VA.  Donald Trump was not asked the question because the candidates were only asked questions up to the level of difficulty that reflects their aptitude.  The last part of Clinton’s response which hinted at the exchange of medical records and ability to schedule patients was this:

“We’re living in a technological world.  You cannot tell me we can’t do a better job getting that information.  And so I’m going to focus on this.  I’m going to work with everybody. I’m going to make them work together.”

Now anyone who has worked in information technology or perhaps is just below the age of 40 would agree with this.  We, as a society do live in a world where sending information from point A to point B is not technologically taxing.  However, we also live a world where this action is somewhat technologically taxing in the realm of Healthcare.  Not healthcare for our pets and livestock, mind you, because veterinarians have been exchanging information for decades, but healthcare for humans.  Why is this?

The Meaningful Use program should be credited with the biggest push to the healthcare industry in to exchange health records electronically.  Yet, even though we are at the tail end of that program, the threshold for the requirement that health records be sent electronically in a secure manner is set at 10% of total transitions of care.  Prior to  Meaningful Use, there were no players in the industry besides patients and providers (You know, the important people) that had incentive to exchange health information.  Now the incentive is only set at a paltry 10% in this world where technologically-speaking, this shouldn’t be an issue.  Oh, and this is in the private industry where the incentive is in the form of Medicare/Medicaid payments to providers (excuse me, their employers) who purchase EHRs that are expected to meet the bare minimum requirements.

Getting back to Former Secretary Clinton’s statement, the VA and the DoD don’t have the same incentive structure.  Their providers aren’t vying for payments from Medicare/Medicaid.  Therefore, their EHR selection choices don’t have to factor that in.  There is no “Free-market”/”Invisible hand” at work, even though we know that’s actually not even true in healthcare to begin with because there are so many different players between the buyer and the seller.

The simple policy answer as to why the VA and DoD can’t exchange health records very well (or schedule patients appropriately), is because they haven’t been directed to do so with proper funding. Even with the recent movement to purchase a new collection of EHRs and consulting firms to update their IT with way too much funding in my opinion (at least inappropriately allocated), there is still the fundamental misunderstanding that EHRs are the solution to taking better care of patients.  EHRs are the solution to gathering better data to develop public health policy.  That’s it. Technology that solves communication and resource allocation problems, which are at the heart of healthcare problems, does exist, but not in the healthcare world.

If I were creating policy around this, I would focus on creating a system (bought or built) with the following points (My first 6-point plan!):

• Efficiently triages patients to the resources that are needed when they are needed while balancing the workloads of those resources.
• Removes barriers to communication between patients and providers.
• Allows public health to gather information relevant to developing public health recommendations.
• Allows public health recommendations to be disseminated and implemented uniformly from the top-down (while allowing providers to override them based on individual patient requirements).
• Integration with active-duty experience to help identify potential care needs for patients.
• Aides the transition process for patients from active-duty healthcare to veteran healthcare systems.

An additional point I might add would be to implement a good ear protection program since hearing loss is the most common veteran injury, but that’s not really relating to IT so to speak.

It would be interesting to develop a system around that policy within the government because it would easily outperform the private sector and the private sector would have no choice but to follow suit.  Sure, there would have to be some additional requirements for insurance companies to provide some information like cost before services are performed, but the idea that communication is vital to health outcomes would be a new a welcomed concept.

I’m an independent consultant and therefore for hire, by the way…in case you need some policy development help.  Just throwing it out there.