Electronic Health Reporter

Guest post Ruby Raley is director of healthcare solutions at Axway. 

One little-discussed but widely recognized aim of the HITECH Act’s meaningful use Stage 2 requirements is to stem rising costs and improve outcomes by engaging the consumer to take control of their healthcare. But how is the consumer supposed to take control of anything when their health plan determines which clinicians and hospitals they can visit, and their doctor controls their health record?

That’s an issue the Department of Health and Human Services (HHS) recognized as they developed the incentives for the HITECH Act. To address it, they adopted the electronic health record (EHR), a tool that (1) helps clinicians and hospitals reap incentives and avoid penalties by proving they’ve achieved meaningful use, and (2) puts the certification burden on EHR vendors instead of clinicians and hospitals.

Still, the EHR isn’t without its own issues. For example, to record EHR information, clinicians must use devices (e.g., laptops and tablets) during the patient encounter, a process that can actually hinder communication if the clinician isn’t skilled at multitasking and engaging the patient — the opposite of what an EHR is supposed to do.

So to address this and other EHR issues — to ensure that the dream of patients taking control of their healthcare is kept alive — EHR vendors, clinicians, and hospitals have been asked to step up their game in meaningful use Stage 2.

For example, Farzad Mostashari, the National Coordinator of the ONC office, is asking EHR vendors to make interoperability — the ability of different systems and applications to communicate and exchange data — simpler, easier, cheaper and faster. He wants the EHR to become part of the base system, despite the fact that it:

• Was designed to support clinical processes and decision-making
• Was never designed to communicate with the outside world
• Doesn’t have gateways built into it
• Doesn’t enable mobile communications very well 

Further, to comply with meaningful use Stage 2, clinicians and hospitals are being asked to provide patients with an electronic copy of their health record so that they can view, download, or transmit their data anywhere they wish. Unfortunately, the majority of clinicians and hospitals seem to believe that they can achieve this by using patient portals — an approach that calls for third-party document sharing, which isn’t a base capability of EHRs. If a vendor delivers that portal using an old-school, client-server approach (and it’s very likely that they will), it’s unlikely that the portal will actually be mobile-enabled, nor will it be flexible enough for the patient to receive information via any system.

This is to say nothing about how this classic type of portal will almost certainly create myriad challenges for hospital IT departments. Since patients must provide their user IDs when requesting health records — and since even the most responsible patients routinely lose those user IDs — the hospital IT departments will be called upon to manage credentials, offer help-desk support, and supply data that didn’t originate in the EHR (e.g., billing, third-party labs, etc.).

Even if they can provide that support, though, can anyone really say that the spirit of meaningful use is being reflected here? That the consumer is being effectively engaged to take control of their healthcare, reduce their costs, and improve their outcomes? That they’re being set up to enjoy dynamic interactions with their physicians?

I don’t think so.

Yet patients do want to set appointments via the web, have their questions answered via email, and enable different specialists using different systems to share care plans with their primary physicians. They do want to question clinicians about notes they made in the EHR, ask for advice, learn best practices, gather quality metrics about procedures and facilities, and compare prices.

Patients instinctively know the level of control they should rightfully have, and while most of them aren’t getting it yet, the fact remains that they could be. A clinician or hospital can give the patients what they want and satisfy meaningful use Stage 2’s requirements, and they can do it by using API server management tools.

These tools empower clinicians and hospitals to: 

• Give their patients the ability to obtain information via a federated identity management system, using their own credentials
• Avoid the burden of managing individual IDs
• Facilitate the exchange of information between systems and services within any facility
• Offer their patients updated billing information through an open, flexible information exchange not restricted to data within the EHR
• Apprise their patients of added-value items (e.g., thought-leadership blog posts written by relevant, in-network specialists)

Indeed, the uncertainty around how to give the patient complete, timely access to health records from disparate systems, providers, and laboratories persists in the healthcare industry. The question of how exactly a patient can collaborate with their clinician and take charge of their health plan — regardless of the complexity or scarcity of the patient’s condition — continues to confound clinicians and hospitals.

But in the near future, all healthcare providers will be expected to realize the dream of empowering patients to take control of their health.

And the first steps toward that future are being taken now. If clinicians and hospitals look for it, and if they’re open to it, they’ll see today — not years from now — how API server management tools will help them realize the dream of empowering patients through interoperability, and they’ll help them realize it early.

The only control issues then will belong to HHS as they strive to persuade all consumers to take advantage of their newfound empowerment.

Ruby Raley is director of healthcare solutions at Axway. With over 20 years of experience, Raley collaborates with prospects and customers  to develop value-added solutions for healthcare and life sciences.  She enables pharmaceutical manufacturers, distributors, healthcare providers, healthcare exchanges, and health plans to meet regulatory requirements while strengthening their IT infrastructure.