(Part Of) What We Need To Battle Covid-19: A National Health Information Network To Replace The Fax Machine

This past week saw record numbers of Covid-19 cases. Hospitals in many areas are becoming overwhelmed, laboratories are racing to process thousands of tests and report results, and public health agencies are drowning due to continued widespread use in health care of a communications technology most young Americans have no concept of: the fax machine

Public health departments are now hiring data entry technicians to help them with the influx of faxes. 

Nearly a decade after the U.S. government invested more than $ 35 billion to subsidize electronic health record (EHR) adoption, the majority of physicians and hospitals today are utilizing an EHR. Yet the benefits of adoption of EHR have proven elusive because these systems are largely unable to exchange information. While there have been industry-led efforts to promote interoperability and public and private alignment around some data standards, seamless electronic exchange of health information is still not easy to come by. The current pandemic is simply highlighting these shortcomings.

One bright spot for health information exchange? Electronic prescribing. Now when most people go to the doctor (in person or virtually with telehealth visits), they won’t walk out with a prescription, but rather are asked which pharmacy they want the prescription sent to. E-prescribing between doctors and pharmacies may be routine now (80 percent of all prescriptions were e-prescribed in 2019). but it took nearly two decades to reach that point. 

If there is one thing that the healthcare industry learned – or should have – from the adoption of both electronic prescribing (e-prescribing) and electronic health records (EHRs), it’s that enabling seamless electronic health information exchange on a broad scale takes time… and trusted, credible company that sits between all of the different end-user software that acts as a convening body and knows how to build a national network to connect all of them and manage the quality of interactions amongst its network of users.

Managing quality on healthcare information exchange networks

Surescripts, which now facilitates transactions between pharmacies, physicians, hospitals and payers, is a great example of a multi-sided platform business responsible for enabling healthcare information exchange on a broader level.

Given the fundamental role of platform-style businesses (think AirBnB, or Uber and Lyft) is to facilitate transactions between different groups of users — in the example of e-prescribing in healthcare, between pharmacies and physicians — it’s essential that networks figure out how to optimize for the “core interaction”. In short, the core interaction is made up of the different users seeking to transact, the thing itself being transacted (information, goods or services), and a filtering process to help users from one side easily find and match with another. 

If platforms’ business is facilitating transactions between different groups of users, then managing the quality of the core interaction is paramount to the platforms’ success. In ride-hailing, a poor interaction is likely to lead to frustration; in health care, poor interactions can result in lack of care, patient safety issues, and worse.

In healthcare, one of the challenges that regional health information exchanges (HIEs) have faced is trying to boil the ocean. With so many different constituents with so many varying needs, it would be virtually impossible to nail a single core interaction between any two groups. Perhaps unsurprisingly, the number of HIEs is declining and there are concerns about their viability. 

What can HIEs and healthcare platforms do to improve the quality of the core interaction?

Success stories: focusing on the core interaction to drive value to users 

Platforms in healthcare thinking about how to drive value for their users and achieve network efforts should focus on the different elements of the core interaction: 

  1. The users themselves, what they are trying to achieve, and what elements are prerequisites for exchange
  2. The “value unit” itself: what the specific information being exchanged is and what components are important for which users
  3. What filtering process can be put into place to make the process more efficient 

Regarding user considerations, key prerequisites for most healthcare users include a high level of trust (is this coming from a known or credible source?), security, privacy, and technical considerations. Commonwell Health Alliance, for instance, relies on an extensive upfront certification process to ensure only systems that adhere to security and privacy measures and meet the technical requirements gain access to the network; it also has published governance, policies and procedures that adopters must agree to. 

Regarding the value unit: while prescriptions may be a small slice of healthcare data,  there are over 20,000 drugs approved by FDA, and the intricacies of data elements and prescriber intent  mean that standardization remains a goal. Accordingly, Surescripts uses standard transactions published by an independent standards-setting organization (National Council for Prescription Drug Plan) and invests in a continuous improvement effort to improve prescription accuracy. 

On the third point (filtering process), CoverMyMeds takes a novel approach to improving the painful process of prior authorization. The company uses a website to improve the arduous process for providers; unlike prescriptions, which have a largely standardized set of data elements, most payers have different data collection forms and requirements for PA requests. This means doctors have to manually search for them each time they submit a PA request to a different payer.

To simplify this process, CoverMyMeds screen scraped 20K+ payer PA forms and put them into a common provider portal, which means doctors can easily determine what’s required by different payers all in one interface. In short, CoverMyMeds figured out an effective filtering mechanism to enhance the quality of the core interaction for doctors.

A national network for lab orders and results would aid in Covid-19 public health efforts

Imagine if there were a Surescripts or a CoverMyMeds that processed 80% of Covid-19 lab tests and results. That platform could be a single point to feed standardized electronic summary results to public health departments, negating the need for thousands of disparate labs to fax results. Electronic summaries could be computer read, automatically ingested and populated into reporting and dashboards needed by public health experts. 

The federal government is trying to solve this type of problem, and is leading by requiring EHRs to adopt common standards and “open up” their systems to allow digital health innovators to connect. Yet the government is also forcing existing HIEs to connect with each other in an attempt to jumpstart health information exchange between them. At the end of the day, it’s impossible to regulate a market into existence

What is more likely to work? Not the federal government boiling the ocean, but entrepreneurs and investors realizing the tremendous market opportunities that exist by increasing information flows for specific clinical use cases, and then focusing relentlessly on improving the core interaction between their platforms’ users.

The author worked at Surescripts from 2010 – 2018 but has no current relationship with the company.

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