Challenges and opportunities in health IT

Health information technology is frequently invoked as the key to solving America’s biggest health care challenges, but as many in the field acknowledge, the gap between vision and reality is often wide. Dr. Karen DeSalvo, HHS acting assistant secretary for health and national coordinator for health IT, shed light on some of those gaps and the ways her team is working to address them at Institute 2015, the annual gathering of America’s Health Insurance Plans. DeSalvo came to HHS after working in New Orleans to foster a health system built around primary and preventive care that harnessed the power of medical home models and connected care to improve quality. These goals are now being applied nationally. Federal initiatives have focused on advancing the adoption of electronic health records. DeSalvo said nearly all hospitals now have EHR systems in place, and physician practices and other professionals have reached 60% adoption rates. However, advancing adoption of EHRs has been bumpy at times, and it is one step in the journey toward goals such as widespread exchange of health data, scaling data-based payment models and ultimately developing a learning-based health system that informs the practice of precision medicine. DeSalvo discussed some of the challenges her office is working to surmount, and she encouraged health insurers and other stakeholders to share their points of view, acknowledging there may be cases in which the government can remove barriers rather than establishing a framework to advance innovation.

  • The EHR interface: DeSalvo said clinicians have in some cases had difficulty adapting to EHRs. “There’s a lot of documentation, and some of it is not intuitive,” she said. “The systems can be very clunky and hard to use on the front lines, and [they are] sometimes a distraction from clinical care.”
  • Workflow optimization: Highly connected health systems that adopted EHR systems years ago have often adapted to the systems and developed ways of incorporating them seamlessly into clinical care. Health systems that have implemented EHRs more recently are less likely to have the bugs worked out. “What we don’t want is for the systems to be in the way,” DeSalvo said.
  • Interoperability: EHRs lay the groundwork for connected care, but linking the systems has been a persistent problem in health care. “The systems don’t talk well to one another. The interoperability at even the data level isn’t as strong as we want it to be,” DeSalvo said, noting proprietary standards and different ways of collecting and storing information -- even something as basic as blood pressure data -- make it difficult to bring disparate data together and glean useful insights.
  • Promoting value-based business practices and culture: DeSalvo acknowledged that changing long-entrenched practices is difficult, but she urged insurers to stay the course. “We need to continue to encourage a business environment that doesn’t reward duplication,” she said, such as repeated X-rays and other tests, by incentivizing value and rewarding providers for taking the time to look into the patient’s medical history for what is needed. “We as a payer at HHS and you all, too, have a responsibility to keep pushing that, it’s going to help influence the culture change.”
  • Privacy and security: “The more we encourage interoperability and systems to connect, the more potential there is for there to be challenges with security,” DeSalvo said. Similarly, more access points to data systems provide more ways privacy can be compromised. She said data suggest patients and doctors generally want to allow use of their data for advancing care, so the system needs to preserve that trust.

DeSalvo also discussed the HHS vision for what health care should be more broadly. The unifying theme is value, but the vision is characterized by better coordination, better access, less duplication of services and convenience that aligns with consumer expectations. Care like that already exists in pockets, DeSalvo said: “You don’t always have to invent the better care. It grows naturally, especially if you’re paying for care differently.” So a key goal is shifting more care to value-based arrangements, and by 2018, the goal is to pay for half of Medicare services under value-based models. Today, one-quarter of Medicare payments are linked to value. And DeSalvo said HHS is engaging private payers in clarifying what mainstream alternative payment models should look like long-term, including working out clear definitions for what constitutes an alternative payment model, refining quality measures and addressing issues like risk adjustment. “This is not something we want to do by ourselves, we want to do this with the private sector,” she said. “We want to do this in such a way that this is not a Medicare program, but it is a change in the way we do business in a sixth of our economy.”