We need to get to the root of the coordination of care problem

Why is there still such as disconnect between the Meaningful Use program's vision of interoperability and its use in the real world?

At this week's Health IT Policy Committee meeting, workgroup members delved deeply into the weeds of the proposed interoperability and care coordination requirements of the proposed rule implementing Stage 3 of the program. Should the acceptable percentage threshold for sending summary of care measures be 50 percent or 40 percent? Should integrated delivery systems be able to include transfers of "selfies" of their own data in their measurements? Should queries be allowed to count, even if they're outside a specific transition/referral episode of care? Should medical assistants be allowed to conduct reconciliations of clinical information?

These are all valid issues.

But what happens when you take these requirements--whichever way you vote on them--and apply them to real life?   

Turns out they may be good measurements but they're not overly useful.

For example, take a look at a new, sobering study published in the Annals of Family Medicine. Researchers from the National Committee on Quality Assurance and elsewhere sought to assess the feasibility of coordinated care objectives in Meaningful Use. The study evaluated the actual coordination of care activities within 350 certified patient centered medical homes, using the 10 activities contained in the six originally contemplated coordination of care objectives for Stage 3 of Meaningful Use in 2012, such as identifying patients who had an emergency department visit, tracking referrals and responding to requests for additional information after referring a patient.

They found that that the clinicians still depended on non-health IT methods to coordinate care. Only one out of five of the homes was performing all 10 covered activities and six out of 10 were using health IT to do so.

Moreover, the EHR systems often didn't support the care coordination activities that clinicians valued most. For example, although 78 percent of the homes viewed timely notification of hospital discharges as very important, only 48.7 percent used health IT systems to accomplish this task. The activity most frequently supported by health IT was providing clinical summaries to patients, in 76.6 percent of practices; however, 47.7 percent considered this activity very important--even though it's an important part of the Meaningful Use program.

And what is striking is not only that the study is fairly recent, conducted in 2014, but also that the researchers specifically studied only practices certified as patient centered medical homes, the providers at the "forefront" of this "developing area."

Now, granted the proposed Stage 3 rule issued in 2015 is not the same as the one contemplated in 2012, and the specific interoperability activities required for Meaningful Use have been tweaked. But here we are, already dealing with the most advanced Stage of the Meaningful Use program, and it sounds like the providers are still going to have trouble meeting the interoperability and coordination of care requirements.

The whole purpose of interoperability is to coordinate care. It doesn't work in a vacuum. Providers are meant to share data so that they can all use it and improve a patient's health.

If even some of the most sophisticated coordination of care providers can't or aren't using their EHRs to accomplish that goal, there's something wrong. Is the bar too high? The implementation faulty? EHR design flaws? All of the above?

There are more fundamental issues here than 10 percentage points of a threshold. If we want care coordination and data sharing to be truly meaningful, we need to delve below the weeds and right into the roots and resolve the disconnect. Otherwise the desired coordination of care simply is not going to happen. - Marla (@MarlaHirsch and @FierceHealthIT)

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