By Matthew A. Michela, president and CEO, Life Image.
In a public health report by the Centers for Disease Control (CDC), the state of the U.S. public health technology was likened to “puttering along the data superhighway in our Model T Ford.”
While the healthcare industry has talked about improving data interoperability with the noble goal of breaking down data silos to better coordinate care and turn data into information, the business of healthcare resisted meaningful change. The status quo that traps data in its silos helped to serve the interests of big, incumbent vendors by locking provider customers into their proprietary tech stacks. In turn, some providers believed they too could protect against patient leakage by holding medical data captive.
Data interoperability is stuck in the past
Even though patients have had, since 1996, a right to access their own information under HIPAA, the healthcare system made it really, really hard to obtain that data. Life Image recently conducted a survey of 1,300 patients and found that 40% of patients had to go to their provider’s office in person to submit requests for medical records. Additionally, 40% received those medical records on a CD, a 1980s technology that is obsolete in the modern consumer world.
In all other industries except healthcare, data requests, collection, storage and exchange are commonplace, and available at your fingertips at any hour and any day of the week. While patient satisfaction and convenience seemed to be worthwhile healthcare goals, they weren’t enough to drive significant, wholesale change and conversion from protectionism, managing resources to optimize the physician rather than the patient, or stubbornly persistent operational practices using CDs.
Nothing happens until something happens
The federal government recognized this inertia and promulgated a lengthy set of interoperability rules in March 2020. Just days later, the force and fury of COVID-19 started hitting the U.S. and created a public health emergency that exposed the significant operational risks and clinical dangers created by the lack of interoperability. Frictionless data sharing was no longer an existential threat. All of a sudden, the hazards became tangible.
The paradox is that COVID-19 has manifested the critical need for exactly what the new federal rules require: advancement of interoperability and digital online access to clinical data and imaging, at scale, for care coordination and infection control. Now more than ever, healthcare needs to be able to digitize, visualize, virtualize, and curate all types of medical data at scale including diagnostic and pathology information without physical exchange. No more CDs, no more faxes, no more film or slides.
Not just data – advanced data
COVID-19 is a respiratory illness with corresponding impacts to the heart, liver, kidney and other organs. People with underlying health conditions such as obesity, diabetes, chronic lung disease and cardiovascular disease appear to be at higher risk for hospitalization and death. Out of the 122,653 U.S. COVID-19 cases reported to CDC, only 5.8% of patients had data available pertaining to underlying health conditions or potential risk factors.
Advanced data such as imaging data are critical to diagnosis, treatment, recovery, and post-care monitoring. The typical structured data found in an electronic health record (EHR) or claims data are easier to access but have limited clinical value. With chronic or complex conditions, advanced data such as medical imaging, pathology and genomics are critical components of the longitudinal patient record that must be easily accessed and shared. However, imaging data has historically been among the most technically challenging to exchange.
While the industry has made some gains in imaging interoperability between large tertiary hospitals and their primary referral sites, patient sharing of digital images online is dismally small.
Patient sharing of imaging data is virtually nonexistent
COVID-19 created a heightened awareness of the challenges of accessing patient information for both patients and their providers, and collecting that data for public health analysis in the aggregate.
Patient portals that store simple forms of medical data (such as lab results) have existed for some time now but they are limited in scope. Most portals can’t handle advanced data such as medical imaging. Most portals only allow patients to view their own information from a single facility. Patients can’t own or share their data. In fact, 66% of patients in our recent survey have access to a portal offered by a provider. However, only 13% of those respondents have received records through the portal, indicating low adoption as a data-sharing platform.
Take advantage of technology that already exists
While the U.S. healthcare system is playing catch up compared to other industries, the good news is that mature technology solutions exist to solve these challenges. It’s not a technology issue, it’s a commitment issue.
Healthcare must make data interoperability a priority and focus its resources on it. Otherwise, we will find ourselves continuing to putt along in our Model T Ford with the same inefficiencies, unnecessary costs, and poor patient outcomes.