Bill Yasnoff has been an evangelist for years, but so far he’s been preaching to an empty congregation. With the consensus failure of the current health information exchange model, he might finally start filling the pews.
Yasnoff, managing partner of the consulting firm National Health Information Infrastructure Advisors, will speak on the business and investment potential of health record banks June 10 during the 2013 Start Me Up Day as part of the Digital Healthcare Conference.
No less than the cause of patient data exchange is at stake because the existing model is an acknowledged failure, and Washington is groping for answers.
In an article published in the Journal of the American Medical Association, Yasnoff explained why the existing institution-centric model has failed. He noted the Office of the National Coordinator reports that in 32 states, more than 90% of the hospitals have not even exchanged a single patient record, and no patients currently receive their care with guaranteed availability of comprehensive information from all sources. He also said the goal of health care IT should be to make available comprehensive electronic patient records when needed.
During his presentation at WTN’s June 10 “Start Me Up” program, Yasnoff plans to discuss how a modest investment in a large-scale health record bank can yield a highly profitable entity in just a few years. He believes health record banks are a very attractive investment for people looking for start-ups in health information technology. “The potential for return is very, very high, and so it’s highly likely in the next six to 12 months that one or more start ups are going to implement large-scale health record banks, because it is a wise investment,” he stated. “So that could happen in the private sector.
“Alternatively, the government could either allow, or better yet promote the health record bank approach through the Office of the National Coordinator. This would help to redirect the existing effort in a direction that could be successful.”
Under the existing model, it’s difficult to get the comprehensive information needed to avoid duplicate tests and medical errors, which are key cost drivers. That’s because the IT architecture prevents an efficient data search. “The key requirement that it doesn’t meet is that you can’t reasonably search the data because if the information has to be retrieved and put together first before you look at it to see if it meets your search criteria, you fundamentally have what computer scientists call a sequential search, where you have to look for one thing at a time,” he noted. “Sequential searches are incredibly inefficient and take huge processing resources.”
In contrast, Yasnoff believes that health record banks address all the requirements for efficient patient data exchange. The banks are central repositories that could function as private entities, much like a financial bank, and be regulated by the government in order to protect patient information from misuse. Unlike the current HIE model, records are controlled by provider institutions; the records in banks would be controlled by patients.
Peter Christman, executive vice president and chief operating officer for the UW Medical Foundation, said the fear is whether record banks would allow for flexible access that provides what physicians need, particularly with regard to electronic health records. “We’ve been at this for about 10 years now, and doctors still aren’t entirely happy with the way they can access it and the variety of options they have,” Christman said. “But it’s gets better and better, and then to become dependent on something that is out of your control, that’s going to give everybody pause.”Yasnoff, who served in the Department of Health and Human Services under former Secretary Tommy Thompson, admits that health record banks are unproven, but unproven models are all that’s left. Not only does the Office of the National Coordinator, which Yasnoff helped set up, recognize the slow development of the existing model, a group of six Republican Senators led by South Dakota’s John Thune have issued a report titled “Reboot,” which solicits alternatives.
“There is an active search going on for alternative ideas to the current approach, which is clearly a failure,” Yasnoff asserted. “There is widespread understanding, although you don’t see a lot of discussion about it, that the current approach is not working.”
According to Yasnoff, it’s not too late to reboot to a more successful architecture because many of the things need to be done for a traditional HIE, also need to be done for a health record bank. You have to move the information and there have to be standards, but the difference is that in a health record bank, patient information is stored in one place and the patient has control over the information.
Yasnoff acknowledges that stakeholder buy-in would be essential for health record banks to get off the ground, and some will be skeptical.
Phil Loftus, CIO and VP of Information Systems for Aurora Health Care, isn’t ready to give up on the HIE model. The remaining problems he sees are the lack of interoperability between vendors like Epic and Cerner, which he believes is gradually being addressed, and the lack of data interchange standards set forth by the government. “Those standards still don’t exist,” he noted.