The Next Frontier in Consumerism

December 20, 2017 10:06 am

Over the years, healthcare interoperability—or the lack thereof—has not been an issue for consumers. Those days are coming to an end. 

The quest for interoperability—the free flow of patient information across geographic, organizational, and vendor boundaries—has taken place largely behind the scenes and out of the public eye. 

Consumers are only beginning to expect our computers to “talk to each other.” Some—especially younger people—realize that incompatible computer systems are to blame for a lot of the repetition, hassle, and inefficiencies that characterize their healthcare experience. For the most part, though, consumers have resigned themselves to the idea that a pervasive lack of interconnectedness is part of the healthcare landscape.  

But consumer attitudes are changing. In a time when consumers are spending more out-of-pocket on their health care, unnecessary repetition of lab tests or imaging or even of taking their medical history is becoming less acceptable to them. Consumers are increasingly connecting the dots between wasteful practices and rising prices and out-of-pocket costs. As forward-looking healthcare organizations—and nontraditional competitors—figure out ways to deliver a more seamless, digitally connected healthcare experience, the rise in consumer expectations will accelerate.

One high-profile, nontraditional competitor that is committing to a strategy predicated on interoperability is CVS Health, the retail pharmacy company. CVS has announced its intention to buy Aetna, with the express intention of expanding into management of chronic conditions in partnership with patients’ specialists. By some accounts, CVS is banking on using Aetna’s health insurance business as leverage to persuade hospitals and physicians to share medical records with CVS’s retail clinics. 

Overcoming Barriers

The reality is that traditional healthcare stakeholders are often reluctant to share information with one another, let alone with disruptors like CVS. As Stan Huff, MD, chief medical informatics officer for Intermountain Healthcare, said in the latest edition of Leadership’s Healthcare Challenge Roundtable, “The single biggest [obstacle to interoperability] is the lack of incentives for systems to be interoperable. The current fee-for-service payment structure actually incentivizes organizations to not share information—to repeat studies rather than ask for results of a study that was done yesterday in a different emergency room.” 

This perspective was borne out in a recent national survey of leaders of health information exchange (HIE) efforts across provider organizations. Respondents were asked to assess the extent of information blocking, i.e., knowingly using business practices that interfere with the electronic exchange of patient health information. 

Fully half of respondents reported that electronic health record (EHR) vendors routinely engage in information blocking, with an additional 33 percent reporting that EHR vendors do so occasionally. The most commonly cited forms were deploying products with limited interoperability, charging high fees that are unrelated to the cost of HIE, and making it difficult for third parties to access standardized data. Researchers ascribed these practices to vendors’ desire to maximize revenue. 

Additionally, 25 percent of respondents said hospitals and health systems routinely engage in other forms of information blocking, which researchers hypothesized are strategies for strengthening competitive-market position by controlling patient flow. (The researchers noted that this is all anecdotal; there is no hard data on the prevalence of information blocking.)

Getting Ahead of the Curve

It’s time for both vendors and providers to reassess their approach to interoperability. Deals like the CVS/Aetna merger should be a wake-up call for those that may not be fully committed to the free flow of patient information across traditional boundaries. Whether that particular deal will succeed is anyone’s guess. But as more consumers experience health care in an interoperable environment, whether in a retail clinic or a physician’s office, rising expectations will become the norm. 

Consumers will be less likely to accept “It’s complicated” or “It’s a technology issue” as excuses from those that are not sharing clinical information electronically. What’s more, consumers will push back—with good reason—if they believe revenue or market-share goals are being prioritized over high-value care. Unlikely though it may seem, interoperability is the next frontier in consumerism.

Joseph. J. Fifer, FHFMA, CPA, is president and CEO, HFMA. Follow Joe Fifer on Twitter @HFMAFifer.


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