Panel: Breaking down information silos: Beyond meaningful use
Breaking down information silos: Beyond meaningful use
Exploring the synergy between electronic health records and research-driven data collection
In the roughly 15 years since the introduction of electronic health records (EHR), how well has it worked? That question, from FasterCures Senior Fellow Kathi Hanna, kicked off the panel she moderated, "Breaking down information silos: Beyond meaningful use." To Hanna, the EHR rollout has worked well, but when it comes to integrating the needs of clinical research into the capturing of data, much still needs to be done. The reality of integrating research needs into data collection still lags the hope.
Yet in the course of the discussion, panelists found abundant grounds for optimism that we are at the threshold of a tsunami of data collected via EHR that will transform clinical research and medical care. For Beth Meagher of Deloitte Consulting, that's partly because of non-health organizations such as Apple and Google, start-ups, and nonprofits all moving into the space.
For Paul Stang, VP of global R&D epidemiology of Janssen Pharmaceutical, the benefits versus risk of EHR are emerging at a different pace. "The unfortunate thing about healthcare data now is that the benefits" are not easily seen, whereas safety issues are well represented because they are clinical events. Another caution regarding the large data sets that are now available: It's easy to get statistically significant results that lack clinical meaning. Janssen has an "active surveillance system" that runs data in a common data model, allowing the company to identify issues before they become bigger than they need to be.
Adam Wilcox, director of medical informatics at Intermountain Healthcare, posed a paradox to the panel: We want to use data on sick people to help them become well, and data on well people to keep them from getting sick -- but we're not stepping back to think if we are using data in the right way overall. "Problems emerge when the question is driven by the availability of the data rather than the interestingness of the question."
For Jon White, the revolution in data-based medical care is captured in his own experience. Now deputy national coordinator of the Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services, White, as a practicing physician 15 years ago, had the common experience of getting patients who had come from a hospital -- but their data did not come with them. In contrast, more recently, when his daughter had a sports accident, the data that had been captured in the emergency room were immediately available and visible on a follow-up office visit.
What's driven this change has not been the technology per se, but incentives to adapt and use it. The 2009 American Recovery and Reinvestment Act encouraged healthcare providers and hospitals to move to EHR, and provided financial incentives to adapt technology and put it to "meaningful use." Today, more than 95 percent of hospitals have received incentive payments.
Now that the data collection infrastructure is in place, how do we make sure it is used in the best way? For White, the precision medicine initiative is an exciting opportunity to leverage what's been put in place to get better research, with a feedback loop that comes back to physicians at the point of care. It's vital to ensure that health data are not just coming in from EHR, but also that the data coming in from personal fitness trackers/monitors are part of the data stream.
The panelists agreed that one of the biggest challenges is "interoperability": without data being captured, shared, and analyzed in a consistent format, the promise from the data revolution will not be realized. Marc Overhage, the chief medical informatics officer of the Cerner Corporation, shared insight from his time at the Indiana Health Information Exchange. The exchange has the ability to gather and share data from across hospitals and providers in Indiana -- but even so had to be ready to undertake "trench warfare" to create a viable solution to interoperability. Overhage's metaphor: we are at a transition stage in interoperability similar to the point when both CDs and USBs co-existed as devices. His key takeaway: systems can and must pursue interoperability -- but must beware of those bright, shiny objects that divert attention. "Don't let pursuit of the latest neat thing divert you from the trench warfare to make the data interoperable."
Wilcox dismissed the tendency to look at HIPAA (the Health Insurance Portability and Accountability Act) strictures as responsible for holding back data collection. For Wilcox, we have emerged from the other side of the data collection issue -- and are now at a stage where we can move to different things. The carrot that increases data sharing is not the money -- it's knowing the value of sharing data. "If they don't want to share data, no amount of money will convince them."