Telemedicine, mHealth will connect with EHRs when providers are motivated

In a discussion at the recent American Telemedicine Association (ATA) conference, panelists bewailed the absence of electronic health record vendors from the meeting, according to a post in NHIN Watch.

"Politically, commercially--it's an issue," said Hon Park, M.D., CEO of Diversinet, which provides secure two-way connectivity for mHealth applications. Pak said that mHealth apps, EHRs, and health information exchanges must be integrated for effective care coordination, according to the post.

Michael Lemnitzer, an executive with Philips Home Healthcare Solutions, said his company is "working aggressively" with EHR vendors to develop interfaces, because 90 percent of Philips' contracts with healthcare providers require connectivity with EHRs. Lemnitzer predicted that by 2015, the majority of EHR companies would have interfaces for telemedicine applications. For that to happen, he said, more interoperability standards would be necessary, according to the post.

This technical approach to the issue, however, leaves out economic and workflow factors that must be addressed before telemedicine and mHealth data can travel "the last mile" to the point of care, to use Pak's metaphor.

In a recent iHealthBeat commentary, Health IT executive and former Accenture consultant David Chase described the problem this way: Current EHRs were designed for a "do more, bill more" system that's on its way out, and they're not nimble enough to cope with the pace of healthcare transformation. In other words, EHRs were not designed for quality improvement or population health management, but for helping practices do things a little faster while enabling them to increase their charges through better documentation.

Even more troubling, the Consumer Partnership for eHealth accuses some EHR vendors of purposely blocking providers' ability to connect with other systems. In comments to the Centers for Medicare and Medicaid Services (CMS) about CMS' proposed Meaningful Use Stage 2 regulations, the Partnership, which represents 23 consumer groups, said CMS should bar such EHRs from getting certification for the purpose of showing Meaningful Use.

To be sure, EHR vendors aren't as bad as these observers make them sound. For one thing, the leading EHRs are all capable of generating and transmitting standardized clinical summaries known as Continuity of Care Documents (CCDs). CCDs convey only key data, but in theory, it should be able to flow into the discrete fields of disparate EHRs. So the vendors won't be able to "block" interoperability.

To Chase's point, the vendors did what he said because that's what the market demanded. Until very recently, physicians purchased EHRs because they believed it would make them more efficient and help them code patient visits higher. Only with the advent of Meaningful Use and the healthcare industry's first tentative steps toward accountable care are we seeing any real interest among providers in using EHRs to improve quality or manage population health. So, while EHR vendors are beginning to offer registries, health information exchanges, and the like, their applications in these areas remain inferior to those offered by third party vendors.

What does this all mean for telemedicine and mHealth? Remember that we're only in the foothills of the major transformation that Chase sees coming. Most providers still derive most of their income from fee for service, so they're still in a "do more, bill more" mindset. Until the reimbursement system changes completely, the percentage of customers who demand that EHRs provide capabilities to thrive under that new payment system will remain small.

As a result, telemedicine and mHealth vendors will have to spend a lot to create interfaces to the leading EHRs, and a minority of the providers who use those systems will be interested in their products. But in the long run--assuming that the industry continues along its current trajectory--the new technologies will play a key role in coordinating care and in engaging patients in self-management. - Ken

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