Public healthcare is, unfortunately, synonymous with long waits for care and lots of paperwork, as well as patients getting lost in the shuffle. The Department of Veterans Affairs (VA) and the Centers for Medicare & Medicaid Services (CMS) are diligently working towards improving the patient experience. A key element involves better interoperability between healthcare systems, as patients face difficulties transferring records from doctor to doctor, facility to facility and EHR to EHR. The solution involves shifting the current thinking about who controls a patient’s data, according to Fred Altimont, Managing Director, Federal Healthcare for Infor. He said that to get to value-based care, where better outcomes are the unit of measurement, it’s time to put patients in charge of their own data.
The journey toward a more integrated healthcare system starts with access to the data, Altimont explained. He said this is well known across the industry, but the issue is about what he calls the “three As”: access, affordability and accountability. Access refers to not only who can see a patient’s records, but who can control that visibility and how it is distributed. Affordability means not just the cost of technology, but also the people cost and the innovation and R&D that goes into managing and routing data. Of course, accountability is critical; patient records must be secured and managed responsibly as they are shared and routed between doctors, patients, and facilities along with VA, CMS and any private insurance companies.
Security is central to this discussion. “From a doctor or facility’s perspective, I’d be worried about sharing this with certain people outside of my environment where they might not have the same level of security protocols,” Altimont said. The problem is compounded by the issue of incompatible systems. Often, he noted, you have to be within a certain geography or medical center for information sharing to be easy.
Altimont gave an example of a Marine Colonel who relocated after retirement. He was given all of his medical records, a stack of paper “5 or 6 inches thick,” which he brought to his new, local VA facility. When he moved again, he had to carry an updated stack of paper to the next VA facility. Still, getting the records into the cloud is only part of the solution. The real answer, Altimont said, is to make the patient the center of the data transaction. “If we give that patient an app, we could say, ‘Here’s your access to it, just like with your bank.’ The patient holds the key.”
This means that if a patient is dealing with a chronic issue, he or she can provide access to the Primary Care Physician, the specialist and other care providers who need to know about treatment and medications. It also opens up new possibilities, Altimont said: instead of busing a veteran from Sacramento to Los Angeles for care, for example, or trying to get a patient from rural Maryland to a medical center 100 miles away, telemedicine and remote monitoring can be used to help diagnose and treat patients with non-emergent issues, so that a “cold doesn’t turn into bronchitis or pneumonia.” This not only improves patient health, it keeps costs from spiraling upward.
“Improving outcomes really means trying to keep the patient from needing to return to the doctor’s office; it resets the metrics to focus on keeping patients well,” Altimont said. It also supports precision medicine, currently a hot topic in healthcare. “Genetic testing for issues like diabetes, MS or cancer can lead to new therapies. But more importantly, it means that you don’t have to wait to get sick to look at treatment, and strengthens the relationship with the care provider.”
To make this work, there need to be standards that allow records to be exchanged easily. There’s also a cultural shift needed for doctors and facilities to give up being at the center of patient data. Next, technology must evolve to catch up to how people use data today. “Even non-digital natives, such as people over 70, use smartphones. They’re using it to stay connected,” said Altimont. And for some lower-income people, such as those on Medicaid, a phone may be their only way to communicate. He suggested that the app needed for access to one’s own data and to connect with providers needs to be simpler than current patient portals; instead, it should be “as easy to use as Facebook or Twitter.”
The private sector is leading the charge toward this patient-centered future. For the public sector, Altimont said that the issue isn’t economic; it’s more cultural, with different standards used in different facilities, plus a concern about the risk of new technologies. “Still, they have the resources to implement the right tools. And there are good people within the public healthcare system – good doctors and nurses, people who care.”
The future, then, will look less like patients and their advocates carrying binders of paper from siloed doctor to doctor. Instead, Altimont described, “I’ll call the shots around my own health as a patient, handing the ball off to each doctor, each lab, each therapist. I’m working with you because you’re invested in my health.”Download the Whitepaper Here