The challenges of data-sharing in value-based care

As Medicare and private payers move toward more value-based care reimbursements, physicians need information to both accurately report data and monitor complex patients across multiple providers. But with interoperability still years away, doctors often struggle to get the information they need. Physicians face many challenges when it comes to tracking quality data and finding solutions for getting the information needed even when technology isn’t compatible.

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Medical Economics spoke with Nancy Pratt, a 20-year healthcare industry veteran and chief operating officer of AirStrip, a company that works on mobile interoperability solutions, about the challenges doctors face in tracking data across the healthcare industry.

Medical Ecoomics: What are the biggest technological challenges facing physicians at smaller practices as the industry moves toward value-based care and the data tracking/reporting it requires?

Nancy Pratt: Health IT innovations have been uneven in their geographical penetration, putting smaller practices with limited resources or breadth of influence at a distinct disadvantage. While many larger health systems in urban areas have access to smart predictive analytic platforms and data aggregation tools that will help them succeed in the transition to value-based care, many smaller, rural practices will struggle to keep pace because of their limited access to the latest health technology.

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The value-based care transition poses a difficult question for practices of all sizes: who will fund and conduct this additional data collection and quality reporting, particularly as many care teams are already at their bandwidth? Evolving guidelines and requirements – such as MACRA – will improve how we deliver care, but may add to current reporting requirements, administrative burden and cost as we first implement them, further stretching small practices to their limits. Even while physicians rely on electronic health records (EHRs) to help report all this data, physicians view these systems as largely inadequate, and too much of a physician’s day is spent on data entry. Consequently, smaller practices will feel an amplified version of the challenges that larger health systems are working to overcome.

ME: What are the obstacles to tracking patient data when a medically complex patient is crossing through various doctors’ offices and health systems?

NP: Health systems across the country have spent valuable resources on implementing EHRs that have yet to fulfill their promise of uniting the disparate pieces of the care continuum. In some places, patients experience truly integrated care delivery. If they have an acute care encounter, then an outpatient procedure, and finally a diagnostic procedure, the care team has access to their respective information throughout the care episode. However, that is not the reality for everyone. Healthcare is still primarily a cottage industry of products, patching things together as they can.

For example, consider a patient with pneumonia. Each of the patient’s multiple interactions with the healthcare system are recorded separately, including doctor’s visits, a radiology visit for a chest x-ray, a trip to the pharmacy, and so on. While common sense would encourage one grouping under the common denominator of pneumonia, health systems across the country have mostly been unable to do so. MACRA encourages providers to link these care episodes and related data, and rewards those who are able to expose and mend care inefficiencies.  

The shift to value-based care ultimately aligns with patient-centric care. However, many practices are unable to access a patient’s data when needed to make quick, informed care decisions. Therefore, while patients have choices in their own care, many health systems are struggling to match expectations due to the difficulty in accessing a complete picture of the patient.

Next: Will doctors ever see true interoperability?

ME: Interoperability is important, but doctors are frustrated with the slow progress. Will doctors ever see the day when all their EHRs can “talk” to one another?

NP: Doctors have a right to be discouraged with our lack of effective interoperability. It is easier to transfer a dollar on a mobile banking app or connect two telephones across the globe than it is to transfer medical data; healthcare is clearly behind the curve. Data access should be similar to electricity – everyone has their own devices powered by the same electrical current. However, everyone in healthcare has their own product, and there is no requirement for them to speak to one another. A small number of large EMR systems still rule the healthcare IT landscape, controlling the ability to access patient information and constraining the ability to integrate easily.

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Healthcare has never had a normal standard for these processes. The key to a world in which patient data is easily accessible and shareable is collaboration among all players in the industry. Health IT is only as effective as its reach, and its reach only goes as far as the ability to work together. While market pressures tend to encourage competition, true integration and smooth patient data transactions will be achieved only if the various players in the industry are incentivized to do so. However, there is reason to be optimistic as previously silent stakeholders begin to speak out and call for collaboration in response to overwhelming industry frustrations. 

ME: With the current state of technology and interoperability, what are some ways physicians can obtain the data they need to successfully participate in value-based care programs, such as MIPS?

NP: There are several approaches physicians can take, with varying costs and benefits associated with them. Having electronic data to extract and submit is the basis of participating in any of these quality incentive programs. Certainly, installing an EMR system in the physician practice is essential. There have been financial incentives for installing these over recent years and any financial assistance in this arena is useful. If there is a community-based Health Information Exchange (HIE), it is useful to subscribe to this. The system provides connections to patient data from other encounters and providers.

These approaches support participation, but not necessarily interoperability. Probably the best approach to interoperability is to participate with a health system that has good vision and infrastructure to support interoperability. Often health systems offer to support or partially support ambulatory EMRs to assure interoperability of information for their patients. The larger medical groups often can fund systems to support their data needs. It is the smaller groups of physicians that are challenged with funding these systems and the personnel to manage them. There is no simple answer to the difficult and expensive realities of collecting and submitting data on patients, which is true for small physician practices and large integrated health systems alike.

Next: Is MIPS fair to doctors?

ME: Is it realistic for the government to expect the necessary data tracking and reporting for MIPS when the technology is still not optimized to do so?

NP: To be fair, the federal government has provided ample warning and instruction to address MIPS reporting requirements. However, 75 percent of providers are struggling to get up to speed with the new program and feel unprepared. The reporting technology at their disposal is partly to blame. EHRs are designed to manage patient care, and are not necessarily designed to optimize performance in value-based programs or extract the requisite variables. Measuring the quality of patient care rather than a focus on fee-for-service is an entirely different way of measuring success for many health care providers. For smaller practices that lack the means to incorporate technology that helps optimize their workflows, MIPS reporting presents a large structural change that requires leadership to educate and strategize.

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As for whether is it realistic to expect this to be done in the current technology environment, the requirement to submit the data will drive the technology solutions. Where the money goes in health care, the solutions follow. So, while it is difficult to launch a program of this breadth and depth, it will result in the provision of services and tools to support this data submission. And, in the end, patients will ultimately benefit.

Nancy Pratt is the chief operating officer of AirStrip.