EHRs and data analysis will play an ever increasing and evolving role beyond the Meaningful Use program as Medicare moves to new health care delivery payment models.
"A different infrastructure will be needed for reform. It depends on data not just in one EHR but a new longitudinal measure," said Kelly Cronin, Director of ONC's Office of Care Coordination, speaking at the American Bar Association Health Law Section's Annual Washington (D.C.) Health Law Summit this week.
In order to transition to newer payment models based on quality and value, data analytics becomes "key," added attorney Sidney Welch, with Kilpatrick, Townsend & Stockton, also speaking at the Summit.
"The EHR is necessary to collect the data. The question is then how to reconcile data sources and move past [the EHR as] a data repository," she noted.
Part of the problem is that the data sets in healthcare are so large that they can't be managed with traditional hardware and software. Healthcare data in 2011 reached 150 exabytes (one million gigabytes), Welch said.
Nonetheless the Department of Health and Human Services is already moving EHRs beyond the Meaningful Use program, requiring both the Medicare Access and CHIP Reauthorization Act's Merit-Based Incentive Program System to use certified EHR technology.
Another problem is the lack of interoperability, which stymies data analytics, Cronin pointed out.
One pilot program from HHS' Center for Medicare & Medicaid Innovation that's incorporating EHR data into analytics is Project CORE (Coordination Optional Referral Experiences) at the University of San Francisco, said Meaghen Quinn, program manager, Association of American Medical Colleges, also speaking at the Summit. The pilot is using EHR based tools to enable electronic consults and integrate patient records and data to enhance decision support.
"It's an opportunity to use the EHR to data mine to the department level, for quality improvement," she noted. Some of the challenges encountered include ensuring that the EHR data is quality data and how to include patient information that's beyond the EHR.
HHS has been steadily requiring or encouraging EHR use into new reimbursement models. HHS intends to speed up implementation of these value based payment models within the next two years.