By Robbie Hughes, Founder and CEO, Lumeon
It is well understood that documenting the actions undertaken in the delivery of care is a hugely important capability of electronic medical records (EMRs). The 2009 Health Information Technology for Economic and Clinical Health Act (HITECH Act) prescribes the “meaningful use” of EMRs with the purpose of enabling health systems to document and account for the care they deliver. But the key question is whether this is enough to solve the problems of care delivery today.
The conversation has moved on since 2009. The reality we face now is that the cost of care is too high, with the cost of care delivery in the United States approximately twice what it should be for the value it delivers. The majority of people do not consider this situation reasonable, but the debate usually centers around the cost of premiums and who should be footing the bill. Should we institute Medicare for all? Double down on the private market?
If premiums were halved across the board, it’s quite likely that the vocal debate about how care should be funded would die down, but looking at where the money goes, the only real way to achieve this is to roughly halve the cost of care delivery – the margins on the payor side are already regulated.
But the debate around cutting care delivery is not an easy one. Nobody likes to be responsible for starting the argument about whether we should be defunding emergency rooms and cutting the number of nurses on the front line. The reality is that we need to change behaviour in order to remove this cost burden: behaviour of clinicians, patients, payors, everyone.
The big question is “How?”.
Since the problem is multifaceted, we likely need to take a multifaceted approach to the solution.
If we start with the patient, we must ask if it is reasonable to expect patients to take responsibility for managing their complex individual needs when those in need of most help fundamentally don’t understand the impact of not doing so. We need to look to education, transparency, and guidance to help guide the patient to the right action at the right time for their condition, and their individual needs. This applies throughout the highly complex care-delivery environment, whether in early-warning primary care or “managed” secondary care.
If we agree we need proactive management on the patient side, the question then becomes one of how to institute this on the provider side? It’s clearly not enough just to expect the patient to do the right thing. What happens if they don’t? How do we respect the fact that life just isn’t like that? How do we provide the management interface between the patient and the health system? Patients texting their primary care docs for everything is just not scalable.
There needs to be a bridge to align the behaviour of the patient to the correct resources of the organization and vice versa. This bridge needs to manage the needs of the patient and direct their needs to the correct resource, whether it’s a physician, a care manager, or an algorithm.
This alignment is how we effectively match the needs of society with the realities of healthcare delivery. It’s a “bridge to value” or an “agility layer” that enables healthcare providers to drive the right behaviors across their populations, from patient to providers and everyone in between.
This is not the job of EMRs. It is the job of a new kind of solution: an intelligent care pathway technology that delivers an air traffic control capability for providers, enabling them to do more with less. If we can get this right, then we might have a genuinely viable way forward for not only cutting the cost of care delivery, but actually improving the quality and consistency at the same time, and this, is truly what the HITECH act should have achieved in the first place.