By Barbara Wirth
Information drives change, and, in today’s digital age, the transformation of the health care system is increasingly linked to the use of health information technology (HIT). The days of hand-written notes, manual chart reviews and paper bills sent to payers by a health care provider practice are all but gone. States increasingly need to collect accurate, timely and actionable measurements electronically and use that data to advance the triple aim of improving patient experience, improving health outcomes for the population and managing health care costs.
The HIT Trailblazer Project highlighted the challenges for states in creating the state-level HIT infrastructure that would align HIT with these goals for health care transformation. Sponsored by the Office of the National Coordinator for Health Information Technology (ONC), Deloitte Consulting LLP, and Research Triangle Institute International (RTI), eight states – Arkansas, California, Maine, Massachusetts, Michigan, Minnesota, Oregon and Rhode Island – received support to ‘blaze a trail’ forward into this complex and fragmented field. The challenges ahead are numerous.
Although many practices have implemented some form of electronic health record, less than half have fully implemented systems that enable the provider, the state, and federal agencies to fully leverage this investment for patient care or quality improvement. When collected, information on patients and their providers is often held in silos in different programs or agencies preventing analysis of all health-related services being provided. The use of HIT also has raised concerns for states over privacy and security issues, the varied and incompatible formats used for reporting both within states and to different federal agencies, and the variable participation by health care providers and other key stakeholders.
The amount of health care data currently being collected at local, state and federal levels is staggering. Historically, collecting data to measure quality in health care was dependent on labor-intensive chart reviews or required relying on the limited information available in claims or administrative data. With recent initiatives such as Accountable Care Organizations, Comprehensive Primary Care Initiatives, and Patient Centered Medical Homes, the measures collected increasingly will need to be used specifically to assess the patient experience and quality of care, to assign accountability and to promote care coordination. (K. M. Anderson, C. A. Marsh , H. Isenstein, A.C. Flemming, J. Reynolds J., “Quality Measurement Enabled by Health IT: Overview, Possibilities, and Challenges,” AHRQ Publication No. 12-0061-EF. June 2012.)
All eight Trailblazer states received either State Innovation Model (SIM) design or testing grants and will build their proposed SIM projects on their Trailblazer experience. Throughout the Trailblazer project, several states specifically focused on examining the measures collected through the wide array of programs in their state, identifying overlaps and then implementing a process to align the measures across their state programs. California, for example, set goals with the priority of “report once” to streamline the reporting process, decrease the burden on those reporting, and increase the use of quality measures by consumers.
States also must build the infrastructure to effectively collect the quality measures and then analyze and provide important feedback in a timely manner across the multiple providers and agencies. Each Trailblazer state defined goals and created a work plan to move this process forward within their state. Rhode Island, for example, focused on how they manage information on identifying health care providers and shared with other states the recommendations for how their state could move toward a unified provider directory. Oregon worked on automating quality reporting for their community care organizations and Maine explored options for data governance addressing the overall management of their health care data.
The lessons learned from the Trailblazer project are important first steps for many states and are described in the brief, “A Vision for Quality Data Infrastructure to Support Health System Transformation.” While each state and the varied stakeholders involved in health care will have individual goals, the brief outlines the overarching elements all will need to develop within their state:
- Core set of quality measures
- Data that flows both efficiently and securely
- An architecture that enables efficient data collection, reporting and feedback
- Access to timely and actionable data
- Providers engaged and motivated to improve care through the use of HIT.
The use of health information technology has the potential to improve health care delivery at all levels from the individual patient’s engagement in their care to the larger systems impacting care delivery, payment and the quality of health of the population. Incentives for states and the healthcare industry to work harder to incorporate HIT may increase as providers face penalties from the federal level for not having full EHR adoption in place starting in 2015.
There are still miles to go as states work to overcome the challenges related to using health IT to advance health system transformation but there is widespread agreement the benefits will be significant. The hard work done by these trailblazing states will help move all states forward into the digital age!