Standardized Standardization of Standards
A few posts ago I wrote about our digital wake and how it could possibly help to improve the quality of care for many individuals. After some consideration it seemed to me that I really hadn’t covered the breadth and width of how data and information technology will lead the charge towards a full value-based model. In fact I’m not even sure I scratched the surface, it’s more like I gave it a gentle knock. Over the next few posts I will explore more and more how data analysis, data science, and information technology are critical pieces to the puzzle and how things are being implemented to overcome the many hurdles yet to come.
A value-based healthcare (VBH) model is really not possible without strongly interconnected systems and coordinated analysis methodologies. As data storage and accessibility become easier and less expensive, healthcare organizations are realizing that there is no longer an excuse for not investing in the tech. A slew of software development companies have moved in as well to help fill the need for reliable and user friendly software packages that can collect and analyze data to help payers solidify their VBH policy decisions. One need only take a look at the exposition hall of the recent HiMSS (Healthcare Information and Management Systems Society) conference to know that practically everyone has what they believe is the perfect sword for the Gordian knot of VBH.
So we have the means. We have the power. We have the desire. So where is the holdup? In truth, there are a number of things that are holding the Healthcare world back from diving full force into value rather than volume.
The biggest bump in the road is standardization. A lot of coordinated care concepts require the use of an electronic health record (EHR) which has the benefit of being instantly available to lots of different providers without the need for bulky faxes or office phone calls. Unfortunately though there are a number of different EHR vendors out there and each of the vendors has their own system of encoding, organizing and displaying information. Since no broad level EHR standard exists right now it’s difficult for providers and hospitals using different systems to interact without having one format converted into another. I don’t want to get too deep into the requirements for EHR, (my colleague Ruthanne has that one covered) but unless there is a working relationship between two providers there is a pretty good chance that the records won’t cross over.
Another area were standardization is key is in the determination of quality metrics and outcomes. Right now pretty much every payer and professional organization is coming up with their own metrics and determinations for the measurement of quality and outcomes. This is to be expected especially since VBH is still in the “toddler” stage of its development. However, if standards are not agreed upon on a large scale, it will lead to lopsided determinations of outcomes. When the determination of the outcome is the key to a patient’s health and wellbeing, the last thing you want is your insurance company being the reason you get one course over another. At the least it should always be the same right?
These are just two examples of the old square-peg-in-a-round-hole thing. Though even a square peg will fit in a round hole if the radius of the opening is greater than or equal to about 70.7% the length of the side of the square. Who knew that your old math teacher would turn out to be right, geometry is useful outside of school! But, how is it relevant? If the standard is the square peg and the round hole is what data is actually collected and how it’s organized then it is possible for disparate systems to work well enough to get everyone on the same page. Admittedly, that is a terrible metaphor but I think it illustrates the point well enough.
Broad scale and industry accepted standards can take a long time to fully percolate and often it takes some larger authority to make the final decision like a large governing association or standards organization. So in the meantime if there can be some tacit agreement and collaboration between the vendors and users of EHR and VBH systems then at least there is a fighting chance for payers to start seeing the benefit of VBH models. Otherwise this concept will sit in the “to do” box for quite some time. Hopefully recent policy decisions and nudges from the U.S. Secretary of Health and Human services as well as many health education and healthcare industry leaders will be enough to keep the momentum going.