A panel discussion about the challenges of health information technology at the 5th annual Patient-Centered Oncology CareÂ® meeting also identified opportunities for providers to leverage better solutions.
WHEN MODERATOR BRUCE FEINBERG, DO,
described the “unfulfilled promise” of healthcare information technology (IT) during Patient-Centered Oncology Care® (PCOC®), he was being kind.
During the panel discussion, “Surmounting Health IT Challenges in Oncology Care,” Jonathan Hirsch, MSc, founder and president of Sypase, had much harsher terms for the software most doctors use in electronic health records (EHRs).
Feinberg, an oncologist whose former practice was an early adopter of health IT, expressed dismay at the thought that the systems into which providers have sunk fortunes don’t give providers what they need. He was not happy about the thought of a solution that would take more time from the work day. “You’re not going to fix this thing that’s broken by making me do more things to overcome what’s broken,” he said.
“That’s the tragedy of how IT has unfolded in healthcare,” said Hirsch, who later described the frustration that doctors and nurses experience having to cut and paste notes multiple times or having to extract data from systems.
But Hirsch and fellow panelists Suzanne Belinson, PhD, MPH, executive director of the Center for Clinical Effectiveness at the Blue Cross and Blue Shield Association (BCBSA), and Carrie Tompkins Stricker, PhD, RN, AOCN, of Carevive Systems, had advice for attendees: the EHR vendors who make money selling their data need providers as much as providers need them, and by being smarter consumers, they can leverage better solutions, greater interoperability, and more results from their systems.
Thus far, health IT has fallen short of its mission of connecting providers in ways that allow faster, evidence-based decisions at the point of care. The rocky start for a new EHR system was cited in January reports that MD Anderson Cancer Center, in Houston, would cut up to 1000 jobs.1 And in an interview with Vox about his healthcare record, President Barack Obama, cited challenges with EHRs as something that didn’t go as well as the administration had hoped.2
Obama cited some of the same concerns voiced by the PCOC® panelists: the interests of technology providers may not align with long-term goals like interoperability—the ability of different health IT systems to talk to each other. “I’m optimistic that, over time, it’s eventually going to get better,” Obama said. “It’s been a lot slower than I would have expected.”
During the November 17-18, 2016, conference in Baltimore, Hirsch, Belinson, and Stricker agreed. But they portrayed a landscape that is about to change, as forces that Hirsch called “wedges” are about to compel interoperability.
The term “wedges,” Hirsch said, refers to a crack in the system that will allow things to break open. In this case, he sees the arrival of genomics as forcing a revolution of health IT in cancer care. Oncology has been one of the worst practice areas for health IT, he said, because patients have so many encounters with so many parts of the health system, over an extended period.
“We don’t need to junk everything,” said Stricker, in response to Feinberg’s question of whether healthcare would have to “start over” with IT. She and the other panelists said what’s coming are complementary systems that will overlay what doctors are using now, but will finally give doctors what they need at the point of care. In cancer care, she said, CMS’ Oncology Care Model will require data sharing from radiology, palliative care, and survivorship care.
As valued-based care takes hold, Hirsch said, the question arises, “How are you going to track patient outcomes on an individual level—and tie to treatments?”
Besides precision medicine, Belinson said, payment reform will compel change because oncologists will demand up-to-date evidence. “As providers are taking on more risk, they need evidence at their fingertips,” she said. “That evidence evolves at a faster rate than any one person can consume.”
These overlay products, she said, must be “agnostic” to whatever EHR the provider is using. While entrepreneurs are working hard to repair what’s not working, Belinson said, “We have to collaborate now in a way that we may have never collaborated in the past. Stakeholder engagement means more than just bringing a patient and provider together,” as payers, pharmaceutical companies, and multiple levels of providers all need to be connected.
Feinberg was skeptical that providers would share their enthusiasm. Hirsch said providers must be their own “wedge” and use their power to force EHR vendors to give them what they need. Do practices ask the question of whether their vendor is selling their data? If that’s happening, what are practices getting in exchange? During the question-and-answer period, speakers discussed the same problem that Obama would mention weeks later—that vendors don’t want to share data because they’ve built a business out of charging clients to get it back.
“Providers don’t realize the power they have to enforce interoperability,” Hirsch said.
The final wedge, Stricker said, is patient engagement—using data to compel better care coordination and ensure that “the care team interacts at the right time,” when the patient needs it. The patients and their families need to be given tools to join in decisions, she said.
Feinberg was not thrilled that a bottom-up, grassroots push for interoperability was needed after all the time and dollars spent on EHRs. He wondered when health systems would see the value in investing on better IT instead of pushing this cost on to practices. Some of this type of investment is happening, the panelists said, but demand from providers was key. “It’s the grassroots that will break down the silos of information,” Belinson said.
The panelists said that major health IT vendors are gaining business by starting to line up their processes with the way doctors practice. Feinberg was still skeptical. Whether future systems are called EHR or something else, he said. “That workflow tool needs to work. And it doesn’t today.”