Atrómitos is honored to have sponsored the Insightful Discussion “Straight Talk on Tech: Implementing IT in Health Care." We are grateful to the panel that participated in this critical and timely discussion.
It is no longer enough for physicians and other health care providers to only rely on their hard-won clinical expertise and experience in delivering care. As the health care system moves (in some cases gets dragged, pushed, or pulled) towards value-based care, it is apparent that effective data aggregation and analysis (and thus technology) are essential. This means providers cannot engage in meaningful quality of care analytics, population health delivery, and value-based payment without a full informatics suite.
And while no one has “cracked this nut” yet, it is clear that there will be a divide between providers that invest in technology and those that do not. Those who invest will enjoy the benefit of maintaining their independence (from large health systems) and attain contracts with higher rates that reflect their ability to manage a population and impact outcomes.
Let’s be clear, investing in technology is not as simple as buying an off-the-shelf big-name technology system. Despite what they may be telling you, the one size fits all approach often creates more challenges than opportunities. The reality is that selecting, purchasing, and implementing information technology within clinical practice is expensive, time-consuming, and requires operational and technical focus. Based on our experience, the systems in question do not (sufficiently) consider the needs and preferences of the user from the beginning. To make informed and tailored decisions that will support your organization’s current needs while allowing you to adapt as external forces require changes, you must "know thyself." This self-awareness requires a team-based approach to identify requirements and design system specifications. Even organizations with the most significant commitment to creating a unified, interoperable system may find the cost of this too great to be feasible.
If this all feels too overwhelming, the good news is that our webinar panelists came to Straight Talk on Tech to share their essential tips and tricks to get you started and help your organization meet this challenge head-on. If you are looking for a trusted partner to guide and support you along the way, Atrómitos offers over 70 years’ collective experience in healthcare policy, regulation, management, operations, and innovation. We are passionately and fearlessly committed to helping you do big things and would be honored to support you through this time of tremendous opportunity.
Michealle Gady, JD
President, Atromitos, LLC
The premise for the technology push is that technology will allow providers to serve more people at a lower price and a more cost-efficient price point while preserving or promoting the quality of care. “That’s a lot of things to do all at once,” laughed Simpson.
Naturally, then, there is much variation across providers when it comes to keeping all those balls in the air simultaneously.
"In the coming years, we will see a continuing acceleration on this trajectory toward more value- based care with a greater focus on technology,” added Simpson. "This has already been happening, but it doesn't seem like anyone has cracked the nut on how to integrate technology effectively or how to deliver population health management.”
Simpson believes a growing divergence occurs between providers who struggle with tech adoption and those who successfully navigate the process, which is understandable given the problems inherent in data based on the healthcare system as it exists today. As Wright explained, getting reliable, ‘clean’ and non- duplicative data attributed to a single patient across a single network is the key to unlocking a higher level of clinical care. Here in the US, the lack of interoperability and clean data is exacerbated because the system is so fragmented. This contrasts with countries such as the United Kingdom, where the system is more centralized, and providers can begin their endeavors to improve data analytics capabilities from a more integrated starting point.
“A patient could walk into four different health systems with four different health records," Wright said. "To rationalize all of them into one person is a difficult task." This fragmentation is a fundamental problem that even the most sophisticated systems have not been able to solve entirely.
Recognizing that this is a universal problem and a problem that will grow in importance in a more mobile, digital world as patients move across health systems, Wright hopes that this being a shared problem will lead to progress in its resolution. Since other countries have made greater progress on this issue, globalization could help to provide a possible solution. As Adapa pointed out, the end goal is to integrate multiple data points about a patient, perform data analytics, and promote learning health systems. However, as Adapa noted, even before capturing and exchanging a comprehensive, longitudinal patient record across health systems, there remain significant blind spots within a single health system. Fragmentation of services is a feature of the American health system, and this carries over to practices within a single health system. Adapa explained that fragmentation and lack of interoperability increase because major specialties within a healthcare system often operate in siloes, looking at one specific corner of the care path and conducting analytics specific to that course of treatment or practice.
“That does not provide a comprehensive view because errors are happening across different stages, and we are not fully capturing all the data points,” said Adapa.
A Closer Look at: Interoperability and Usability
All panelists agreed that, after ensuring reliable, 'clean' nonduplicative data points, the most significant challenges presented by health technology platforms were those of interoperability and usability. Interoperability refers to the ability of different systems to exchange data effectively. In contrast, usability reflects how effectively a given user can use a product within a given context to achieve the intended result. As it relates to both, part of the problem is that Electronic Health Records (EHRs) were initially developed around revenue management. The objective was to capture every billable activity conducted by a provider in any engagement with a patient. The transmissibility and clinical integration of the platform, while important, began as a secondary feature to what was, essentially, a billing machine. The impact of this design has been exacerbated by how EHRs are regulated: until recently, EHRs were validated based on lab results and were not tested in a clinical environment.
“Very often, these EHR systems truly don’t match the needs of the end-users,” said Adapa.
As demonstrated by Adapa's research, progress is being made related to usability. But we still have a long way to go. One pathway to improved usability, particularly as it relates to information overload, focuses on improved interoperability across systems, and that is focusing on a minimum data set.
To this end, the National Coordinator for Health Information Technology developed a standardized
set of health data classes and constituent data elements for nationwide, interoperable health information exchange, referred to as the United States Core Data for Interoperability (USCDI).
Simpson pointed out that this is just a mandated set of the clinical measures that EHRs have to cull and be able to exchange. "Instead of capturing every possible data point, you need a minimum data set for everything,” explained Adapa. Medical providers should partner with the tech vendor they select during the development phase to figure out what that data set needs to be.
“It’s incumbent on the vendor and their customer success team to design a solution with the end goal in mind," said Wright. It starts with getting all of the necessary constituents in the room, so a list of the desired requirements can be created, and the technology can be customized to those needs.
“Then, the lawyers can come in and document that in the context of acceptance criteria,” added Wright.
“The conversations have to start long before the legal paper passes.”
No Blind Faith — Test and Verify
Providers need to be wary of inflated promises from any sales team, particularly regarding technology. In many cases, the sales team does not possess an in-depth knowledge of how the technology works. "From the beginning, you need to have internal expertise on your contract needs, and it’s important not to rely on vendor assurances,” noted Simpson.
Wright, who built her law practice around complex contract negotiations for Software as a Service, noted that timing is critical. Setting clear expectations in the negotiation phase as far as establishing acceptance criteria, project planning, and requirements gathering are paramount. "But you lose all your leverage once you've signed the contract," advised Wright. This means that providers need to push back on vendors that want to establish these critical elements after the contract is signed but before a project plan is developed.
More specifically, after a contract is signed, medical providers likely have limited recourse if their purchased technology does not align with expectations. Regardless of what a salesperson may have said as a part of the sales cycle, their opinion about the core functionality of what technology is supposed to do is meaningless unless explicitly stated in the contract.
“It’s vital to slow down and take the time to really think through the requirements,” explained Wright. It is also critical to understand that outsourcing a technology solution does not equate to outsourcing risk or responsibility.
Tackling Security Issues
Finally, assuming you have found a platform that meets your specifications, that doesn’t mean it is clear sailing. Understanding your risk profile and the shared responsibility related to data privacy and security when you purchase a platform is also essential.
Again, an ounce of prevention is worth a pound of cure. During negotiations, have a person on hand who understands encryption and can ask the hard questions about how these systems work. "You may not need this person all day, every day for 10 years. But you certainly need them as you’re architecting and designing the solution,” noted Wright.
This vigilance and responsibility don't end once a platform or process is implemented. As Gady noted, "In 2021, around 50 million healthcare records in the United States were breached." Data breaches through ransomware attacks and other incursions present a significant operational and financial risk and threat to an organization's reputation and credibility. And this is a risk that is increasing in scope, frequency, and severity. Providers must adapt to this changing digital and regulatory environment, requiring a culture shift across practices.
Many providers do not have an IT security expert on staff, or IT is focused primarily on maintenance and operational support and not on proactive cyber defense. While understandable, given the narrowing margins in healthcare, it is a mistake. Providers cannot avoid liability by stating the vendor said the system is HIPAA compliant and therefore secure; instead, they need someone to vet adequately the claims put out by the vendor.
“You can’t just outsource this; you need to conduct your own risk assessments and have a trusted adviser, someone who knows what you don’t know,” explained Simpson.
The Bottom Line
The key takeaway from this discussion is that there is no one-size-fits-all approach to managing or implementing healthcare information technology. Still, the potential benefits from taking the necessary steps could be substantial. Providers should begin with reasonable expectations about the process and functionality and a clear understanding of how the technology should work after it is implemented. Finally, providers need to enlist the required expertise to identify internal needs, evaluate vendors and platforms, contract successfully, design and implement the technology, and ensure appropriate ongoing maintenance and security.
Atrómitos is an SBA-certified woman-owned business headquartered in Wilmington, NC. The Atrómitos team has expertise in strategy, innovation, and change management; policy and research; operations and contracting; and technology, security, and compliance. Atrómitos works with small to mid-sized organizations in the health and human services sector. Through their work, their mission is to help create healthier, more resilience, and more equitable communities.