Regardless of how the Supreme Court rules on the president’s healthcare reform at the end of March, many of its elements are here to stay. At issue in the Supreme Court decision is the ability of the federal government to mandate that every citizen have healthcare insurance or face tax penalties. But there is much more to a broader agenda of healthcare reform that will drive new business activities and technology.
These will be one of the biggest process and technology transformations in our history. If we’re smart, we’ll involve events, rules, social, mobile, continuous improvement, supply chain and every other ‘new’ way of doing business. It will start with Electronic Medical Records (EMR), continue onto compliance in data transfer (5010 and ICD-10), capped by a grand finale in the adoption of CORE (AKA: The Big Payoff). Nothing this big happens easily.
Outcome vs. fee-for-service
The greatest transition is the move from healthcare providers as stand-alone silos of increasingly costly services to a cohesive network of organizations measured by patient health outcomes. You can’t dispute that this is a necessary thing, but why is it so difficult?
For starters, medical professionals have been compensated for discrete services that have an associated fee. This was the reason for the creation of the ICD-9 codes that are now obsolete. Measuring outcomes is an attempt to end ‘coin-operated’, siloed healthcare. Restructuring this model from a payment and technology angle is an enormous challenge.
Healthcare collaboration
Breaking down treatment silos also means being able to move data in a privacy-protected way (those privacy protections are known as HIPAA regulations). The 5010 data standard and EMRs are the first step. This is much more than reducing the stacks of paper in storage. When doctors’ notes, treatment plans and prescriptions are on paper, there’s no way for that information to be used by the physiologist, the radiologist or the outpatient facility. It is very difficult to expect a collaborative outcome if there isn’t a modern, protected way for everyone involved to share information. The outcomes are also much more difficult to compare and analyze. Keep in mind collaboration doesn’t have to be through traditional means (nor should it be).
Secure, enterprise-level social media is a powerful form of EMR and a brilliant collaboration platform that can bring together the patient, the medical professionals and the patient’s support community (i.e. non-medical). This is game-changing and needs to be thought through.
Information transparency
Once everything becomes electronic, it can be moved between applications in a standard way. This won’t happen if traditional healthcare technology vendors continue to build applications and systems that won’t expose data easily so that they can be shared.
At some point, avoiding this becomes a critical part of the healthcare reform plan. Many systems have been built on keeping data ‘inside the walls’, which coincidentally ensures that healthcare IT customers are forever stuck with software. This practice is known as vendor lock-in. The traditional ‘vaults’ of information need to be opened or replaced, and that won’t happen without a fight.
A recent TechCrunch article compared the state of healthcare IT to where newspapers were a few years back…acquiring, taking on debt, and not modernizing.
OK, you’ve just gotten the overview of the storm that’s coming. When the dust settles, we should have something better than today, regardless of political issues.
