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How IRIS Puts the Real Triple Aim of Healthcare In Action

Posted on November 22, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I’ve been doing my Fall Healthcare IT Conference tour, I’ve had the chance to meet with hundreds of companies and thousands of people working to improve healthcare. While all this travel takes its toll, I also come away from all of these meetings invigorated by the quality of people and their desire to make healthcare better. That’s true almost across the board.

While most of the solutions I see are an evolution of something I’ve seen before, every once in a while I meet with a company that’s really impacting healthcare in a unique and interesting way. I found just such a case when I met with Patrick Cresson from IRIS – Intelligent Retinal Imaging Systems.

On face value, many might look at IRIS as just another diabetic retinopathy exam that’s been done by ophthalmologists forever. While this is true, what makes IRIS unique is that they have an FDA cleared exam that can be done in the primary care setting as opposed to being referred to an ophthalmologist. As Patrick pointed out to me, of all the diabetic screenings that need to be done for diabetic patients can be done in the primary care setting except for the retinal exam. At least that was the case before IRIS brought those exams to the primary care setting.

A look at the numbers is quite telling. There are 116 million patients with diabetes or pre-diabetes and that number is increasing every day. It’s estimated that 30 million diabetes patients get referred for an eye exam every year and 19 million diabetes patients do not get the annual retinal exam. There are plenty of reasons why this is the case, but it’s not hard to see why this happens. The same thing happens with referrals across healthcare. Diabetic patients that can’t tell any difference in their eyesight are unlikely to keep going back for an annual retinal exam. Who really wants to go to the pain of scheduling an appointment for what doesn’t seem to be an issue? So, they don’t.

The problem with this thinking is that diabetic retinopathy is asymptomatic. The only way to know if you’re heading for trouble is to have a retinal exam. The good news is that early detection can solve the problem and literally save diabetic patients’ eyesight. I know this first hand since it saved my grandfather’s eyesight.

This is the compelling story that IRIS tells as it pushes the retinal exam into the primary care setting where they can ensure patients are getting the early screenings they’ve so often missed in the past. This plays out in the numbers. Over the past 3 years, IRIS has performed 120,000 diabetic retinopathy exams which resulted in 56,000 patients identified with a pathology and 11,600 patients saved from potential blindness.

While this type of early detection can help healthcare organizations HEDIS compliance, I’m intrigued by the way IRIS straddles the fee for service and value based care worlds. I’ve seen very few models that get a primary care provider paid in the fee for service world, but also work to significantly lower the costs of healthcare in a value based care world. However, that’s exactly what you get from IRIS’s early screening exams.

What’s also fascinating to consider about IRIS is ophthalmologists’ response. It’s easy to see how many ophthalmologists could be afraid of diabetic retinal exams being done in the primary care setting and not in the ophthalmologists’ offices. That’s taking business away from them. While this is true, it’s also easy to see how an increase in retinal exams will drive more previously undiagnosed higher acuity exams, surgeries and interventions to ophthalmologists. Every ophthalmologist I know would much rather do a higher acuity surgery than a basic diabetic retinopathy exam. That’s the reality that IRIS creates since it’s an FDA cleared exam for diabetic retinopathy, but it’s only a screening tool for other eye diseases that require a full exam by an ophthalmologist.

Stories like IRIS are why I love blogging about healthcare IT. IRIS is changing healthcare as we know it by reducing healthcare costs, improving the patient experience, and getting doctors paid. That’s the real triple aim of healthcare in action.

Where’s the Humanity in Healthcare?

Posted on September 8, 2016 I Written By

The following is a guest blog post from Snarky Frog. Yes, that’s her real name. Ok. You got us. No, it’s not her real name, but that’s how she wants to be known online. Who are we to judge her if she loves frogs and snark that much?
Snarky Frog
There was a time when I blogged. There was a time when I wrote about living with POTS (Postural Orthostatic Tachycardia Syndrome) and EDS (Ehlers Danlos Syndrome). There was time when I wrote about having a parent who…well…if I were to explain in this piece, I would lose all credibility.

There was time when I thought people would read what I wrote. There was a time when I thought people would care about how my father died (Yes hospital in CT, I do hold you accountable for that).

There was a time when I thought people would care that when I was half conscious after fainting, a nurse took it upon herself to show me what happens to drug users – apparently folks who use drugs have no rights to sexual dignity.

I wasn’t using illegal drugs then and I don’t now. The more you read about POTS patients, the more you read about how strange our symptoms are. I still argue my symptoms don’t matter, the way I was stripped of my humanity did and still does – turns out nobody really agrees with me. Guess you can do whatever you want to drug users (I’ve since learned this again and again via EMTs and others). As it turns out, you can also pretty much do this to patients you think are faking their disease.

There was a time when I blogged about how I couldn’t understand that a patient advocacy org promoted things one day, disagreed with them the next, then went back and forth for years. By the way, what’s still up with that? Will exercise heal me or is it IVIG I need or is it small fiber neuropathy all around? Oh… you need to study more – well hate to tell you patient group, if I need IVIG, exercise won’t save me. Though, it honestly may help.

There was a time in life when I questioned things. There was a time when I wrote. There was a time I cared. I probably still do all of those things but I do all of it less.

Nobody cared what I wrote so I stopped publicly blogging. The things I tried to get folks to care about – I was on my own with. I wrote but my writing was for me. I took my blog pieces down one by one.

By that time my writing abilities were somewhat gone after I had taken a few too many hits to the head. Things became mostly jots on google docs. My posts are now long gone into the ether and even the WayBackMachine can’t find them.

Right now I could write about not having a single doc who knows much about any of my diseases. I could write about having 3 different specialists who each understood different pieces of EDS / POTS leave their practices in the same year. I could write about fighting with hospital billing offices. I could write about how a doctor who played a role in quality affairs at an academic medical center could literally get nowhere with my insurance when he tried to get me some assistance. I could write about the discussions I have had with the insurance co regarding how much my POTS costs them (about 90-100K in 2015, likely to be more this year) and the various suggestions I’ve given them to lower those costs. I could write about how they respond with the fact that none of those suggestions, while cost saving to them, are part of my plan, and as such, are not things they can or will do.

I could write about my grief over a friend. I could write about the things I saw happen to her the one time I visited her in the hospital. I could write about how I wanted to help more but couldn’t.

I could write about system failures. I could write and I could write and I could write some more about how every single part of the system has failed me and has failed my friends. It might not all make sense but I could write. The irony is the thing that matters to me the least is the specific cost yet that’s what people care about.

I care about the fact that my friend died.

I care about my losses as a human being. I care how much of my human dignity I have lost and how much has been taken away from me since I started getting sicker. I care about the fact that I will likely lose my job (days off, their having to worry or perhaps lack of worry about my falling on the job, my requests for accommodations etc.). I care about the fact that I will never be able to do what I wanted to do with my life – PhD, fieldwork – yeah, not a chance.

I care about the fact that I will eventually get so physically injured by a fall, by EMTs, by hospital staff, or other that I will no longer be able to get out of bed. I care about the fact that I will forever wonder whether one of these things will kill me, and if so, when.

I can give you the health care cost numbers but they don’t matter to me. Ask any chronic illness patient for his or her own costs of care and you’ll find the same thing. Once you go past “typical” or “trendy” chronic illnesses, there is no care coordination, there is nobody to turn to for help, and your insurance company, well maybe they’ll pay for something and maybe they won’t. I do wonder, if I were sick and rich would I still be as sick?

One thing I do know, I’m damned tired of being sick. I’m tired of identifying myself that way and I’m tired of others doing so. I’m also tired of wondering if it’s in my head and tired of having people tell me it is. (And if it is all in my head, then please, by god, someone help me treat that.)

If creating a blog post that delineates each and every expense will help me find a doctor who can help me with whatever the heck is wrong, yes, I will write one. That said, that post would take away a part of me, the part that says humanity matters most and that’s what we should care about.

This post is part of our effort to remind us of the patient perspective by sharing patients’ stories. Thanks Snarky Frog for sharing your story with us. If you have a patient story you’d like to share, please reach out to us on our Contact Us page.

Physician Burnout

Posted on July 26, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

At the HIMSS Annual conference, I talked with Vishal Gandhi, CEO of ClinicSpectrum, about a popular topic at the conference and well beyond: Physician Burnout. You can watch the full video interview I did with Vishal below:

Physician Burnout is such an important topic and I love that Vishal commented that physician satisfaction (the remedy to burnout) is good patient care and an appropriate reward. As it is today, the trend is to ask doctors to compromise good patient care and we’re paying them less in the process. Is there any wonder why physician burnout is so rampant?

Vishal also commented that healthcare technology is used more for documentation than patient care. He argued that the tech piece has focused far too much on documentation as opposed to focusing on the patient. I’d argue that if we focused the tech on the patient, doctors would appreciate technology much more and would be less burnt out.

Finally, I’m always interested to hear what non-EHR technologies Vishal and ClinicSpectrum have launched to make a practice more efficient and profitable. He outlines a bunch of them in the video above. Take a listen and see if some of them can make your life easier and your practice more profitable. It’s time we start considering technology outside the EHR that can make a practice better.

When Will Doctors Teach Patients to Not Come In for a Visit?

Posted on July 8, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been thinking and writing a lot about the shifting medical reimbursement world. Technology is going to be an enabler for much of this shift and so understanding the changes are going to be key to understanding what technology will be needed to facilitate these changes.

As part of this thinking, I recently wondered when a doctor will start teaching patients when they shouldn’t come for a visit. I realize this is a bit of a tricky space since our current liability laws scare doctors from providing this kind of information. Dealing with these liability laws will be key to this shift, but if we want to lower the cost of healthcare and improve the patient experience, we need to make this change.

Turns out, we already do this in healthcare, but it’s not so formal. Plus, it’s usually the older, more experienced doctors that do it (from my experience). I think the older doctors do this for a couple unique reasons. First, hey’ve had years of experience and so the patterns of when someone should go to a doctor or not are very clear to them since they’ve seen it over and over for 30 years. Second, they aren’t as worried about patients returning in the future, so they’re not afraid to educate the patient on when they shouldn’t come for a visit. Third, these older doctors are likely tired of seeing patients for something that’s totally unnecessary.

We’ve had an older pediatrician that did this for us and our children and we loved the experience. In some ways, I think he just liked to hear himself talk and we loved it as parents. There’s no handbook you get as a parent and so we wanted to learn as much as possible about how to take care of our child. Since we had 4 children, we were able to use that knowledge pretty regularly, but even so, it was hard to remember 6 months or a year later what the doctor had told us. It was all very clear when he explained it in the exam room, but remember when to take them to the doctor and when to wait it out was often forgotten 6 months later.

The decision of when to go to the doctor and when not to go to the doctor is always a challenge and I always forget when I should and when I shouldn’t. Far too often my wife and I error on the side of caution and take our kids in for needless visits. We don’t want to be irresponsible parents and not take them. With my own personal health, I likely wait too long to go to the doctor because I’m busy or I can just tough it out when a quick visit to the doctor would make my life better and avoid something worse.

I guess this is why we see so many health decision tree apps out there. They try and take the collective knowledge and help you as a potential patient know if you should go in for the doctor visit or not. However, most of them are really afraid to make a hard conclusion that you shouldn’t go to the doctor. Instead, they all end with some sort of disclaimer about not providing medical advice and that you should consult a healthcare professional for medical advice. I’m not sure how we overcome the liability of really offering a recommendation that doesn’t need the disclaimer. Although, this is exactly what many of us need.

What do you see as the pathway forward? Will the consumer health apps be our guide as patients? Will doctors start spending time educating us on when to come for an office visit and when not to come? Will they want to do this thanks to ACOs and other value based reimbursement? Will doctors leverage the consumer health apps or a PHR tool to help their patients with retention of the concepts they teach them about when to come in for a visit?

Duplicate Work in Healthcare

Posted on July 7, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of my favorite stories is the time we implemented an EHR in the UNLV health center. At first, we decided to do a phased implementation in order to replace some legacy bubble sheet software that was no longer being supported. So, we just implemented enough of the PM system to handle the patient scheduling and to capture the charge data in the EHR. Of course, we were also a bit afraid if we implemented the full EHR, the staff would revolt.

A week or two into the partial implementation, something really amazing happened. First, some of the providers started to document the patient visit in the EHR even though they still had to document it in the paper chart as well. I asked them why and they just said, “It was there and I thought it would be good to have my info in the note.”

Second, some of the providers started asking me why they had to do duplicate work. They really hated having to enter the diagnosis and charge codes into the EHR and then document them again in the paper chart. Plus, they followed up that they could see the other section of the notes in the EHR and “why couldn’t they just use that instead of the paper chart.” The reality was: Doctors hated doing duplicate work!

Once I heard this, I ran to the director of the Health Center’s office and told her what they’d said. We both agreed, why wait? A week or so later we’d moved from paper charts to a full EHR implementation.

There were a lot of lessons learned from this experience. First, it’s amazing how people want to use the new system when they can see that it’s possible. They basically drove the EHR implementation forward. However, what was interesting to me was the power of “duplicate work.” We all hate it and it was a driving force for using technology the right way.

While we used the concept of duplicate work for good, there’s a lot of duplicate work in healthcare which drives patients and healthcare staff totally nuts. However, we don’t do anything about it. This was highlighted perfectly in a recent e-Patient update from Anne Zieger. Go and read her full account. We’ll be here when you get back.

What’s astounding from her account is how even though doctors hate duplicate work for themselves, we’re happy to let our patients and support staff do duplicate work all the time. I’ve seen some form of Anne’s experience over and over. Technology can and should solve this. This is true across multiple clinics but is absolutely true in the same clinic where you handle the workflow.

I get that there are reasons why you may want a staff to verify a patient’s record to ensure it was entered correctly and is complete. That’s absolutely understandable and would not have likely been an issue for Anne. However, to disregard the work a patient had done on their intake paperwork is messed up. Let alone not tapping into a patient’s history that may have been entered at another clinic owned by the same organization or collecting/updating the info electronically through a patient portal. I’m reminded of @cancergeek’s recent comment about the excuse that “it’s how we’ve always done it.”

In the past this might not have mattered too much. Patients would keep coming back. However, the tides of consumerism in healthcare are changing. Do you enjoy doing duplicate work? Of course not! It’s time to purge duplicate work for patients and healthcare staff as well!

3 Benefits of Virtual Care Infographic

Posted on May 20, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The people at Carena have put out an infographic that looks at 3 ways virtual clinics are improving care quality. I’d like to see better sources since most of the sources for the data in this infographic come from virtual care providers. However, it’s also interesting to look at the case virtual care providers are making so we can test if they’re living up to those ideals.

What do you think of these 3 benefits? Are they achievable through virtual care?

3 Ways Virtual Clinicals are Improving Care Quality

Halamka Ponders The Need to Leave Medicine If We Continue Our Current Trajectory

Posted on May 5, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The famous Dr. John Halamka, Hospital CIO, Doctor, Former member of the HIT Policy committee, blogger at Life as a Healthcare CIO, recently read the 962 page MACRA NPRM and he wrote up a detailed look at the IT elements of MACRA. The post is worth a read if you’re interested in MACRA. Especially if you don’t want to spend the 20 hours reading it that he spent.

MACRA aside, he ends his post with this bombshell of a comment:

As a practicing clinician for 30 years, I can honestly say that it’s time to leave the profession if we stay on the current trajectory.

A doctor in the comments shared a similar view to Dr. Halamka:

Wow, I feel exactly the same as you do. As a front line ortho provider in a small group. I think now I get the message. CMS and ONC wants us out of private practice, either retire, or join as a salaried doc or hospital employee. That is the only justification for this 1000 page nightmare.

We’ve written a lot about physician burnout and many doctors distaste of all this government regulation, but having someone like John Halamka comment like this is quite telling. What’s scary for me is that I don’t see much light at the end of the MACRA tunnel from a physician perspective. Do you?

The Virtual ACO

Posted on April 26, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

“Virtual ACOs may be the next big thing for small practices,” says our host Dr. Tom. “I want to talk about how independent practices can lead and not just follow the shift to value-based care.”

Who here has looked at or talked to someone about virtual ACOs?

My guess is that most small practices haven’t really heard about it. Maybe it has to do with most doctors being too busy to consider other innovation. I’ll admit that the idea of a virtual ACO is a new one to me and so I was interested in the discussion that Dr. Tom from Kareo led on virtual ACOs.

The concept of a virtual ACO makes sense. Basically use technology to provide coordinated care across the care system. In fact, that’s what most patients think is already happening with their care, but we know it’s generally not happening. We all know it should and most doctors would embrace the ability to have the right information in the right place so that their patients get the right care. I don’t know anyone who’s against that principle.

However, as was pointed out in the chat linked above, the financial model for a virtual ACO is up in the air. There’s no clear financial model that makes sense. The care model makes sense, but the financial model is a mess.

Dr. Tom did make this assertion in the virtual ACO discussion:

Although S. Turner Dean responded with something we’ve talked about quite a few times before:

I love Dr. Tom’s optimism that this new world of value based reimbursement simplifying things, but I’m not sure it will be any simpler than fee for service. That’s not even taking into account the fact that we have the whole infrastructure set up to handle fee for service and that we know how it works. Set that aside and I’m still not sure that a virtual ACO would be any less complicated than our current fee for service world.

What do you think of the concept of a virtual ACO? Will it simplify medicine? Will it help doctors love their work again? Will it help the independent physician practice survive?

Full Disclosure: Kareo is an advertiser on this blog.

How Many Doctors Take Time to Explore New Practice Innovations?

Posted on April 22, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Over the 10 years I’ve spent blogging about healthcare IT, I’ve had the chance to talk to more doctors than I can count. For the most part, I’ve been impressed by how incredible these doctors are and their desired to provide amazing care to their patients. Their desire to do the right thing for their patients is powerful and gives me a lot of hope for the future of healthcare.

While I think that most doctors hearts are in the right place, I fear that most of them don’t spend enough time thinking and planning for the future of their practice. When does a doctor spend time exploring new innovative opportunities to improve their practice? When does a doctor have time to try out new approaches or to think deeply about how they could improve the patient experience?

There are a few doctors that can spend time thinking about these types of things. They work for large health systems as employed doctors. Sure, they’re busy too, but do generally have less to worry about. However, these doctors have almost no power to implement or test and changes to the way they practice medicine and the patient experience.

I’m not really blaming doctors for this problem. I realize that they’re super busy people. I’m sure many of them would love the opportunity to spend time reinventing the practice of medicine and the patient experience. If they had the opportunity, they’d happily take it. The problem is that most of them don’t think they can get off the proverbial hamster wheel that requires them to see patients in 15 minute increments.

I think this is a problem and I don’t see any easy fixes.

If you’re a small practice, when was the last time you implemented something that really transformed the way you practice medicine for the better? When was the last time you implemented something that wasn’t part of a government mandate? When was the last time that you spent time talking with your patients about their experience at your clinic and ways that you could make it better?

I’m sorry to say that I think the answers would all reflect the reality in healthcare that we don’t spend enough time on progressing the practice of medicine. I’m sure that some doctors would argue that they’re fine with the status quo. They don’t see a reason to change. Short term that strategy could work. Long term I think that approach will come up wanting.

Our Uncontrolled Health Care Costs Can Be Traced to Data and Communication Failures (Part 1 of 2)

Posted on April 12, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

A host of scapegoats, ranging from the Affordable Care Act to unscrupulous pharmaceutical companies, have been blamed for the rise in health care costs that are destroying our financial well-being, our social fabric, and our political balance. In this article I suggest a more appropriate target: the inability of health care providers to collaborate and share information. To some extent, our health care crisis is an IT problem–but with organizational and cultural roots.

It’s well known that large numbers of patients have difficulty with costs, and that employees’ share of the burden is rising. We’re going to have to update the famous Rodney Dangerfield joke:

My doctor said, “You’re going to be sick.” I said I wanted a second opinion. He answered, “OK, you’re going to be poor too.”

Most of us know about the insidious role of health care costs in holding down wages, in the fight by Wisconsin Governor Scott Walker over pensions that tore the country apart, in crippling small businesses, and in narrowing our choice of health care providers. Not all realize, though, that the crisis is leaching through the health care industry as well, causing hospitals to fail, insurers to push costs onto subscribers and abandon the exchanges where low-income people get their insurance, co-ops to close, and governments to throw people off of subsidized care, threatening the very universal coverage that the ACA aimed to achieve.

Lessons from a ground-breaking book by T.R. Reid, The Healing of America, suggests that we’re undergoing a painful transition that every country has traversed to achieve a rational health care system. Like us, other countries started by committing themselves to universal health care access. This then puts on the pressure to control costs, as well as the opportunities for coordination and economies of scale that eventually institute those controls. Solutions will take time, but we need to be smart about where to focus our efforts.

Before even the ACA, the 2009 HITECH act established goals of data exchange and coordinated patient care. But seven years later, doctors still lag in:

  • Coordinating with other providers treating the patients.

  • Sending information that providers need to adequately treat the patients.

  • Basing treatment decisions on evidence from research.

  • Providing patients with their own health care data.

We’ll look next at the reports behind these claims, and at the effects of the problems.

Why doctors don’t work together effectively

A recent report released by the ONC, and covered by me in a recent article, revealed the poor state of data sharing, after decades of Health Information Exchanges and four years of Meaningful Use. Health IT observers expect interoperability to continue being a challenge, even as changes in technology, regulations, and consumer action push providers to do it.

If merely exchanging documents is so hard–and often unachieved–patient-focused, coordinated care is clearly impossible. Integrating behavioral care to address chronic conditions will remain a fantasy.

Evidence-based medicine is also more of an aspiration than a reality. Research is not always trustworthy, but we must have more respect for the science than hospitals were found to have in a recent GAO report. They fail to collect data either on the problems leading to errors or on the efficacy of solutions. There are incentive programs from payers, but no one knows whether they help. Doctors are still ordering far too many unnecessary tests.

Many companies in the health analytics space offer services that can bring more certainty to the practice of medicine, and I often cover them in these postings. Although increasingly cited as a priority, analytical services are still adopted by only a fraction of health care providers.

Patients across the country are suffering from disrupted care as insurers narrow their networks. It may be fair to force patients to seek less expensive providers–but not when all their records get lost during the transition. This is all too likely in the current non-interoperable environment. Of course, redundant testing and treatment errors caused by ignorance could erase the gains of going to low-cost providers.

Some have bravely tallied up the costs of waste and lack of care coordination in health care. Some causes, such as fraud and price manipulation, are not attributable to the health IT failures I describe. But an enormous chunk of costs directly implicate communications and data handling problems, including administrative overhead. The next section of this article will explore what this means in day-to-day health care.