If smartphones can connect us to the world, why can’t our EHRs?

My Take

If smartphones can connect us to the world, why can’t our EHRs?

By Doug Beaudoin, vice chairman, US Life Sciences & Health Care leader, Deloitte LLP

Pull the smartphone out of your bag or pocket and take a look at it (maybe you are already holding it while reading this blog). Now imagine you can only call or text people who use the same brand of phone, or who rely on the same wireless carrier as you. It would be incredibly limiting, right? But this isn’t an issue because smartphone manufacturers and wireless carriers use an interoperable platform. Interoperability technology allows for the unrestricted sharing of secure data between a variety of sources. It makes it possible for my phone to connect to your phone—or to other mobile devices—to share information, or to interact with apps, fitness trackers, and other devices regardless of the operating system or manufacturer.

In health care, interoperability is in the nascent stages, but significant progress is being made. There is an acknowledgement among stakeholders that interoperability is both essential and inevitable. The technology needed to digitally connect systems and devices across disparate systems in health care already exists. So, what's holding it back? Data from health systems, physician offices, health plans, medical technology firms, biopharma companies, and government agencies still exist in their own siloes. All of these data sets are disparate, disconnected, and not standardized. Bringing everything together in a useful manner to produce actionable insights in real time is difficult and costly. But understanding how investments and time and money would likely lead to dramatic clinical and business improvements could help to justify the costs.

Execs cite security, lack of data standards as biggest obstacles

The Deloitte Center for Health Solutions recently released the results of its interoperability survey, which is based on responses from 100 technology executives from health systems, health plans, biopharma companies, and medical technology companies. We also interviewed more than 20 technology experts to find out how close we are to interoperability today…and what it might take to get there tomorrow.

Survey respondents agreed that interoperability would likely lead to lower care costs, improved care coordination and outcomes, and a better patient experience. They also acknowledged that interoperability will likely become increasingly important as value-based contracting becomes more prevalent.

Our participants were most concerned about what they saw as a misalignment of data standards, how to define short-term returns on investment, and the lack of a national patient identifier. Organizations use a variety of standards to define data elements. One executive told us their organization had two coders—one of them used the word “medicine” and the other used the word “medication.” A lack of even intra-organizational data standards is surprisingly common, and it can lead some executives to raise concerns about “semantic interoperability.” While some participants said it was fine to use multiple standards as long as they can map to each other, few of them said they were working to map these elements.

Can stakeholders collectively solve the interoperability puzzle?

Our ability to gather various bits of data from electronic health records (EHRs), claims, apps, clinical trial databases, wearable devices, and sensors—and connect them to each other—could lead to a far deeper level of insight into our health. Radical interoperability of data is the idea that bringing disparate sets of data together will lead to a 360-degree view of a person's well-being. This real-time information might help encourage consumers to be more proactive about decisions that affect their health and well-being or enable care teams to nudge patients to make healthier choices.

While competitive self-interest and a lack of trust among stakeholders might be deeply engrained in the health sector, just 23 percent of our respondents saw trust as being a barrier to interoperability. Executives agreed that they collectively share the responsibility to solve the interoperability puzzle.

Five strategies for leading the interoperability charge

Most of the executives we surveyed agreed that interoperability would be extremely important to their organization over the next three to five years. Stakeholders that want to emerge as leaders in their use of data and analytics in the future of health should:

1. Prioritize interoperability at the leadership level by developing a clear understanding of how important it is to the organization’s overall strategy, what interoperability will enable for the business, and a vision for interoperability in the future.
2. Invest strategically rather than tactically by seizing the opportunity to focus on next-generation solutions and ensuring that all key business strategies (population health, M&A, value-based contracts or pricing strategies, precision medicine) align with the organization’s interoperability strategy and future vision.
3. Establish a competency center that is responsible for the organization’s interoperability technology stack, data and interface standards, and leading architectural practices and patterns to drive adoption, increase competencies, and accelerate value.
4. Include interoperability in partnerships. Stakeholders should be active, open, and curious. Interoperability could lead to new opportunities to collaborate with traditional competitors, large technology companies, start-ups, or community organizations.
5. Leverage upcoming compliance, privacy, and security regulations as a catalyst to drive enterprise momentum. Organizations that seek to leapfrog their interoperability capabilities can use these opportunities strategically to create momentum, visibility, and competency.

When we meet with clients, we try to explain that interoperability is quickly becoming a necessity in health care and life sciences. Being able to share data internally and externally—and in a timely, useful, and cost effective way—is going to be table stakes a few years from now. By 2040, we might not remember a time when our health and personal information wasn't right at our fingertips. It might be like trying to remember what it was like when our phones were big, clunky, and anchored to a wall in the kitchen.

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In the News

CMS releases Hospital Value-Based Purchasing program results, pays $1.9B in bonuses for inpatient care

On October 29, the US Centers for Medicare and Medicaid Services (CMS) released the Hospital Value-Based Purchasing Program (VBP) results for fiscal year (FY) 2020. The VBP program ties what Medicare pays to hospitals under the Inpatient Prospective Payment System (IPPS) to the quality and cost of inpatient care. This program, which began in 2012, applies to about 2,700 hospitals throughout the US. According to the agency, almost 60 percent of hospitals nationwide will see higher or lower Medicare payments for FY 2020. Hospitals are more likely to receive a higher payment adjustment than a lower one for FY 2020—this was also the case in FY 2019. More than 1,500 hospitals will receive higher Medicare payments for FY 2020, totaling $1.9 billion in bonuses overall.

(Source: CMS, CMS Hospital Value-Based Purchasing Program Results for Fiscal Year 2020, October 29, 2019)

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VA, CMS partner to improve protections for veterans’ health care

The US Department of Veterans Affairs (VA) and CMS have established a partnership to exchange Medicare Sanction data to improve health care for veterans, the organizations said on October 29. Through this exchange, the agencies will work to identify fraud and abuse by comparing data that might indicate questionable clinicians and practices in VA facilities and the community. One outcome of this initiative might be identifying clinicians who are no longer suitable to work for VA medical centers. The partnership, which will go into effect at the end of the year, is expected to help the VA identify and address problems earlier and more systematically.

(Source: CMS, VA, Health and Human Services partner to improve health care protections for Veterans, October 29, 2019)

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House unanimously passes two PBM transparency bills

On October 28, the House unanimously passed bills that call for public disclosure of the rebates drug manufacturers give to pharmacy benefit managers (PBMs). If enacted, one bill would require the US Department of Health and Human Services (HHS) to post aggregate rebate data, by drug class, from Medicare and commercial health plans. The bill would also require Medicare Part D plans to provide patients with information about their cost-sharing responsibility for certain drugs and alternative therapies in a format that can be integrated into electronic health systems. To help beneficiaries with comparison-shopping, Medicare plans would have to provide information about out-of-pocket costs for drugs at multiple pharmacies.

The House also cleared a second bill through voice vote. If enacted, the bill would give both the Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC) access to drug-rebate and pricing information from Part B and Part D plans.

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Health coverage costs ticked up just 3 percent in 2019, Mercer finds

Employers spent an average of $13,046 a year providing health benefits to their workers this year, up 3 percent from 2018, according to Mercer’s annual National Survey of Employer-Sponsored Health Plans. The October 28 report found that health benefit rate increases have been held to the low single digits for the past eight years. The study also confirmed that fewer employers are limiting coverage choices to high-deductible health plans (HDHPs). The National Business Group on Health reported a similar trend in its annual survey of large employers. According to Mercer, 16 percent of jumbo employers (i.e., more than 20,000 employees) offered only HDHPs in 2019—down from 22 percent a year earlier.

The study also found that while nearly 90 percent of employers have made telemedicine services available to employees, uptake has been slow. Last year, an average of 9 percent of eligible employees took advantage of the benefit—up from 8 percent a year earlier. However, one in seven employers reported usage rates of 20 percent or more, and a growing number of employers have made teletherapy visits available to make it easier for employees to connect with mental health professionals, according to the report.

The report is based on a survey of 2,558 employers that have at least 10 covered employees.

(Source: Mercer, Mercer Survey Finds US Employers Shifting to Innovative Strategies To Make Healthcare More Affordable For More Employees, October 28, 2019)

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Report to Congress proposes measures to limit drug shortages

An October 29 report to Congress said that drug shortages are increasing—which could cause challenges for hospitals. Drug shortages often occur for older and relatively inexpensive drugs, according to an analysis of 163 drugs that went into short supply between 2013 and 2017. The median price per unit of all the drugs in the analysis was $8.73. Drugs in short supply include treatments for childhood cancer and medications for patients who have weakened immune systems. The report proposed financial incentives that could encourage continued production of older and generic drugs. The report also recommended legislation to penalize drug manufacturers that fail to timely notify federal regulators about anticipated shortages.

(Source: The Wall Street Journal, FDA Recommends Measures to Curb Drug Shortages, October 29, 2019)

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Breaking Boundaries

Can a high-tech approach to back pain keep employers from straining their benefit budgets?

Back pain and other musculoskeletal conditions are among the top expenses for employee health benefits and make up about one-third of all worker injury and illness cases, according to the Occupational Safety and Health Administration (OSHA). While factory workers might be more prone to injury, sedentary office workers might also be at risk. Rising health care costs are leading some companies to try new strategies, including an upfront investment in prevention. Here’s a quick look at five companies that are trying to address employee back pain:

• Rosen Hotels & Resorts, an Orlando-based chain, offers morning stretches for hotel staff, a free gym, plus an onsite primary care clinic that includes a physical therapist and chiropractor. The company says these initiatives have contributed to declining health costs.
• Brakebush Brothers Inc., a Wisconsin-based chicken processor, worked with a vendor to survey workers about repetitive injury pain. The survey results identified one specific spot in the factory line where workers were reaching too much. Targeting the pain point and taking steps to address it helped reduce health costs.
• Hinge Health, Inc. helps employers reduce the need for surgeries and opioids among their workers. Hinge’s programs include sensor-guided exercise therapy, cognitive behavioral therapy, one-on-one coaching, educational materials, team discussions, and activity and symptom tracking. The company provides tablets to employees, which are pre-loaded with exercises specific to their condition.
• Physera, Inc. provides employers with a telehealth physical therapy service and pop-up physical therapy clinics for employees. The value-add for employers, according to the company, is reduced imaging and surgery.
• Kaia Health, Inc. offers a digital physical therapy platform for back pain, which guides users through exercises at home. The company says the technology and service can be an alternative to pain killers. The platform primarily focuses on treating musculoskeletal disorders, but also includes exercise and wellness tools aimed at treating chronic obstructive pulmonary disease symptoms. 

As detailed in a recent My Take, some employers might be trying many options to reduce health care costs. Employers will likely continue to watch each other and evaluate their own successes (and missteps) to further innovate their strategies.

(Source: Beth Pinsker, Workers in pain: Employers take a new twist to prevent costly injuries, Reuters, October 23, 2019)

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