Interoperability Can Determine the Success of Patient Engagement
Interoperability — or lack of it — has been a challenge since healthcare providers first began to implement EHRs (Electronic Health Records). In 2014, the Office of the National Coordinator for Health Information Technology (ONC), part of the U.S. Department of Health and Human Services (HHS), released a paper outlining a 10-year vision for achieving an interoperable health IT infrastructure. Noting that “An interoperable health IT ecosystem makes the right data available to the right people at the right time,” the paper suggested that “By 2024, individuals, care providers, communities and researchers should have an array of interoperable health IT products and services that allow the health care system to continuously learn and advance the goal of improved healthcare.” Two years in, however, many hospitals are still struggling to share health data within their own organization, even as the amount of data grows exponentially. And many healthcare consumers have begun to wonder “What’s the hold-up?”
5 Barriers to Seamless Use of Health Data
Just two years ago, according to data from the ONC and the American Hospital Association (AHA), nearly 97 percent of hospitals had an EHR, but only 23 percent were able to find, send, receive and use data effectively. Fast forward to 2016, and many hospitals still struggle with the same issue. At the most recent ONC annual meeting, American Hospital Association Vice President, Health Information and Policy Operations Chantal Worzala said that AHA member organizations still have trouble sharing and using data. Worzala likened the problem to needing a different phone for each person you want to call, noting that, for most hospitals, current sharing methodology is “highly inefficient, expensive and limiting.” Barriers fall into five distinct categories:
- Technical. Many hospitals struggle to share data because partner organizations lack compatible systems, making it difficult to exchange data. Providers have also had difficulty matching patients, which leads to incomplete or inconsistent records, and struggled to receive data from non-EHR sources.
- Operational. Getting into the swing of data exchange has created some issues within the hospital workflow. According to ONC and AHA data, 30 percent of hospitals reported that the new workflow is cumbersome.
- Financial. The price tag for EHR implementation was significant, and for at least 25 percent of hospitals, the costs of getting an effective data exchange running represent an ongoing financial burden that has not yet yielded the savings promised by improved quality of care and higher patient engagement.
- Semantic. The American Health Information Management Association (AHIMA) notes that EHRs have the potential to be used by a wide audience — healthcare providers, patients, labs, pharmacies, insurance providers and more. Unfortunately, data inconsistencies abound across disparate systems — just consider varying terms healthcare organizations use to describe high blood pressure or heart disease. AHIMA contends that to realize interoperability, “... electronic health information must be precisely defined, captured, and communicated in a timely manner. In other words, data content must be standardized.”
- Security. Given HIPAA privacy requirements and some recent, widely-publicized data breaches, hospitals and other healthcare organizations are understandably anxious about protecting data. The burgeoning wearable health technology industry only increases the need to adequately address data privacy and security concerns.
As hospitals, EHR vendors, industry organizations and the government pool their efforts to build out a seamless data-sharing infrastructure, these barriers must be addressed.
Is Poor Interoperability to Blame for Lack of Patient Engagement?
Today’s consumers expect far more from healthcare experiences. Having assumed a greater share of the financial burden for their care, consumers want experiences that more closely mimic those they have with retailers. And interoperability does make a difference. As Mohit Kaushal and Margaret Darling wrote in a Brookings Institute report earlier this year, 60 percent of Americans want to communicate electronically with their providers. The rapid growth of mobile fitness and health app usage by consumers — who want to see the data they’re accumulating be put to good use — only increases the need for improved interoperability. And most providers are on board — with 81 percent indicating that they would use mobile access to aid in care coordination and 58 percent showing interest in remote patient care. Clearly, the problem lies not in lack of interest.
When hospitals and healthcare systems make the leap to true interoperability, the advantages begin to stack up. In Iowa, for example, five healthcare systems coordinate care using the Statewide Alert Notification (SWAN) system. The system allows Medicaid care teams to receive real-time notifications about emergency room visits, admissions and discharges for more than 630,000 Medicaid patients across 100 hospitals. Kelly Jones, a care team coordinator for the participating Broadlawns healthcare system, says, that having this level of integration has proved “… particularly useful for patients with complex medical conditions who are seen regularly at outside organizations and who would be unlikely to notify us of an admission.” As a result, healthcare providers capture a more complete picture of patient health, improving both care coordination and patient engagement.
What Else is Needed to Drive Patient Engagement?
A smooth exchange of data and a focus on meaningful use represents the tip of the iceberg when it comes to patient engagement. The Brookings Institute report noted another important consideration, however: “Creating this experience with new and emerging technologies,” the report said, “requires continual consideration of patients’ self-management and healthy behavior motivations, providers’ practice patterns, and how to deliver useful information at the point of decision making.”
In short, data itself — health data, demographic data, financial data — doesn’t offer insights into the unique motivations and expectations of healthcare consumers.
If hospitals want to provide individualized experiences — ones that more closely resemble the retail experiences that consumers crave — they need to understand what drives a patient to engage in their own healthcare. Turning meaningful use into meaningful connections is impossible if hospitals continue with a one-size-fits-all approach that bases communications on shared demographics or shared diagnoses.
Psychographic segmentation helps hospitals gain valuable insights into healthcare consumers’ expectations, motivations and preferences for a more personalized approach that enables higher levels of patient engagement. Using the c2b Consumer Classifier allows hospitals to send a simple 12-question survey to a population of patients for classification into five distinct psychographic segments. Armed with that knowledge, hospitals can fine tune messaging and patient engagement tactics to improve care plan adherence within the specific segments — Willful Endurers, Priority Jugglers, Balance Seekers, Direction Takers or Self-Achievers.
Patientbond is a platform that automates patient communications (e.g., emails, texts, Interactive Voice Response) and customizes messaging through psychographic segmentation. PatientBond is cloud-based, so a hospital does not need to purchase software, and it works with any EHR or EMR. PatientBond has demonstrated reductions on hospital readmissions, increased patient satisfaction, high patient engagement and even improved payment collections to help with revenue cycle management.
National Coordinator Karen DeSalvo, MD, admitted at a meeting earlier this year that while the healthcare industry is making progress, we have miles to go. Standardization, patient privacy and data security are just first steps along the road to true interoperability.
“Today,” DeSalvo said, “we think about data as something that we have to hold tightly onto; it is built into our DNA of medicine that we want to hold data and we're worried about exposing it.” Compared to the other hurdles, overcoming a reluctance to “play nicely and share” should be child’s play.