Making Innovation Work For EHR Integration, Interoperability

October 10, 2016 - Improving healthcare interoperability will require innovators to move providers beyond their dissatisfaction with early EHR and health IT systems and adopt integrative technologies capable of improving care coordination, delivery, and cost.

According to most recent federal data, 97 percent of hospitals and 75 percent of office-based physicians use certified EHR technology. Despite of these high levels of EHR adoption, provider EHR dissatisfaction remains common and the contributing factors manifold.

Given the latter, how does the industry make good on its investments in health IT systems to achieve healthcare interoperability and enable providers and patients to work together to improve the health of individuals and populations?

At Health2047, the solution is bridging the gap between clinicians and developers. The for-profit integrated innovation company got its start thanks for $15 million in funding from founding partner, the American Medical Association (AMA). And its goal? To effect system-level change in United States healthcare, says CEO and Director Doug Given, MD.

Doing so requires bringing together a variety stakeholders — clinicians, developers, investors, etc. — to identify and develop technologies that providers can rapidly adopt and make use of to improve their workflows and the outcomes of their patients.

READ MORE: NIH Grant Funds Machine Learning Tool for Chronic Disease Detection

"We're looking at things that are integrative and trying to combine insights, ideas, and the capacity to develop and finance those to get them in a home for rapid adoption at scale," Given tells HealthITInteroperability.com. "You can't do that with small point solutions."

The approach embodies lessons learned in previous attempts at using information technology to transform how providers and patients interact.

"One of the key problems with usability that arose from the entire EHR history was a lack of attentiveness to that — and also a lack of specification building," Given explains. "There just was no requirement to do that because of the way the financing came out through meaningful use. So we ended up with this very incomplete, unsatisfactory, and full-of-friction system that is better than it was before but nowhere near what it could have been."

A lack of physician input into EHR designed combined with limited EHR usability had a lasting effect on the provider community — one that must be faced head on in the development of new health IT solutions.

"Providers end up being captive to the technology — the technology is making them less efficient — and they're not having any kind of enthusiasm for the user experience," Given maintains. "As a consequence, they won't use the lousy products. The way the lousy product manufacturers put it is that physicians are slow adopters. I'd make the case that they're really rapid adopters, but they're a difficult market because if something isn't useful and as soon as they've tried it and seen that, they discard it. You give them a great product and they become among the earliest and most profound adopters."

READ MORE: Hartford Healthcare Partnership Focuses on Digital Health Innovation

Why Health2047 came to be

According to Given, the raison d'être behind the creation of Health2047 was to address three industry-wide challenges: cost inflation, poor return on investment, and decreased productivity.

In order to make rapid adoption possible, the company is bringing the provider community into direct contact with leaders in the tech community.

"The best asset member of each asset class really is who we want as our partners," Given insists. "Because these groups would be working at the interfaces between the industries, we think the standards would lead to open, scalable, and extendable solutions rather than new siloes and new ways to hide, protect, and sequester data and perpetuate this interoperability problem we all face."

At the center of the designs the organization is looking to develop is provider-centric usability.

READ MORE: Nuvance Health Pilots At-Home Remote Patient Monitoring Program

"The innovation process, first of all, needs to be focused on useful modules — that's the way you get rapid adoption and you don't have to fight all the entrenched investment that's sitting there, whether it's stone-age type infrastructure or not," Given explains. "Rapid prototyping for clinicians needs to have the input of the clinicians."

Rather than an incubator or accelerator, Health2047 will develop its own designs for health IT solutions for investors to buy in to. While the goal is to have more than 60 design concepts in 5 years, its near-term goals are more modest: 2 in the first year and 3-4 in the second.

And those earliest concepts will focus on pain points for providers using various forms of health IT, such as interoperability, health data exchange, and provider-patient interaction. While Given declined to go into detail as to the specifics of these concepts, he did not that the emphasis was on modernizing a healthcare ecosystem that was designed for a particular way of doing business.

"As much as 85 percent of the healthcare spend relates to chronic disease now in American, and we've still got a legacy system that was set up for acute, institutional, hospital-based, intermittent, and periodic care," he asserts. "It's the wrong design for the healthcare burden we have now, which is largely longitudinal with a big emphasis on wellness, prevention, and management over time with behavioral change. The system is not set up to do that effectively. It's not funded against those objectives."

Chronic disease is among connected care, the transition to value-based reimbursement, and inefficiencies in workflows and workforce development as the company's main areas of focus. 

Consistent with the aim of system-level change, the beneficiaries of these design concepts will span the care continuum.

"We have a particular interest in not just solutions for the 400 academic medical centers in the country but rather the 3500 or more hospitals that are less than 200 beds, the small- and medium-sized physician practices that don't have the information system environment to let them function like these highly-geeked-out technical organizations in the big centers," Given adds.

Effecting change in healthcare via healthcare IT is a tall order and many have failed. But how many of these gambles had a direct line to a body of physicians? And while it's too soon to speculate about the long-term prospects of Health2047, its near-term focus on EHR integration, interoperability, and usability is right in line with the causes of physician frustration with health IT.

Dig Deeper:

• How Epic Systems Is Advancing Healthcare Interoperability
• How Behavioral Health Complicates Health Data Exchange