Dr. Bill Yasnoff has an uphill climb in his quest to have centralized health record banks replace health information exchanges.
The preferred method of sharing patient data was a topic that was woven in and out of discussions and session programs during the recent Digital Healthcare Conference produced by WTN Media. The 2013 conference explored a variety of industry stressors that are unfolding as the Affordable Care Act nears full implementation.
One source of stress is the work that remains in creating an efficient model for sharing patient information between hospitals and health systems. Under Yasnoff’s concept, health record banks will serve as a central repository run by a private sector entity and regulated by the government, much like financial banks, with data controlled by patients, not by health care providers.
Yasnoff, managing partner of the consulting firm National Health Information Infrastructure Advisors, believes a consensus has developed around the need for an alternative to HIE. He cited a 20-page report titled “Reboot,” issued by six Republican U.S. Senators, and a request for information from the Office of the National Coordinator, an office he helped establish while serving under former Health and Human Services Secretary Tommy Thompson. Both documents solicited new ideas for health information exchange.
The current model of sharing between providers is a concept Yasnoff believes will fail because it’s not comprehensive enough to avoid duplication and not efficient enough to provide relevant health information without a time-consuming search for data. He contents that HIE is increasing, not moderating, health care costs because cost reduction is predicated on the availability of comprehensive patient records.
Said Yasnoff: “How can you avoid duplicative tests if, when you see a patient, you don’t have information about the tests that were done elsewhere? You can’t. You’re just going to do those tests again. So if everyone has their own electronic records, but there aren’t comprehensive records available for each patient, we’re not going to see the cost savings because those cost savings come from the comprehensiveness of the record. That is a very, very important point that is often glossed over.”
Yasnoff and others noted that communities like Indianapolis have established a central repository for electronic medical records. Some consider it a failure, a point Yasnoff does not dispute because the community does not allow patients to control the information. “That essentially is an obstacle for them in acquiring and using comprehensive information, which then is an obstacle in generating value from that information,” he stated. “It’s that value that really makes the health record bank approach sustainable and gives you the benefits that I’m talking about.”
Not so fast
While Yasnoff believes a consensus has formed that the existing health IT model has failed, not everyone in the health care industry is ready to raise the white flag. Dr. Frank Byrne, president of St. Mary’s Hospital in Madison, is not familiar enough with health record banks to have a strong opinion of them, but he says it’s premature to call health information exchange a failure.
Bryne said patient data exchange would be an evolutionary process marked by incremental progress. “It’s a complex issue,” he stated. “There are people out there trying to make a business out of storing my health care records for me. Will they be successful? I don’t know. I think it’s too early to make a call on that. I’m not opposed to other things, but I think it’s premature to call health information exchange a failure.”
Peter H. Christman, executive vice president and chief operating officer for UW Medical Foundation, also cited incremental progress with HIE, and expressed concern about becoming dependent on something — a record bank — that is out of the provider’s control. Under Yasnoff’s proposal, medical records would not be considered proprietary to the provider, but instead would be controlled by the patient. Providers would work with the record bank to gain access to patient data, not exchange data among themselves.
“That’s going to be the problem,” Christman stated. “What incremental value do you add with the health care record bank? We run multiple clinics. I’ve got, right at this moment, hundreds of doctors accessing medical records and talking to patients. If the bank isn’t fluid in providing that interactivity, do you run into problems? If you have control over it, and if it goes down, if there are problems, at least it’s your problem to solve.”
Phil Loftus, CIO and vice president of information systems for Aurora Health Care, said most CIOs would like to have a set of national interchange standards for the sharing of key data elements – information about allergies, past use of medication, and a list of the patient’s medical problems. At the moment, the lack of interoperability between systems means providers lose the richness of data.
“If we had a standard way that all the vendors support, then it would become easier to share that information,” Loftus said. “We could do it system-to-system or in some kind of state or regional health exchange. The problem is those standards still don’t exist, and the problem then is that although you can work around them, it’s at a very high cost.”
Dr. Barry Chaiken, who chaired the conference, has worked with Yasnoff on a project involving health record banks. Chaiken said the concept makes sense, but noted the issue is becoming less critical because consolidation has brought more collaboration around health information exchange. “Now you have these large providers that are all connected to each other who encompass a major region,” he explained. “There is less competition among them around wanting to hold onto data.
“The concept Dr. Yasnoff came up with is a good one, but the market is moving in a different direction. It prevents some of the good ideas for health record banks, which is the ability to consolidate data and monetize it and offer privacy protections.”
But many believe the government’s privacy guarantees are eroding. While details are still emerging about this, the Washington Examiner has reported that under a new HHS rule, issued late on Friday, June 21, protected health information can be shared among federal agencies in order to verify that applicants to the ADA exchanges are receiving all the “essential benefits” in their health insurance coverage.
If true, it’s not going to help the cause of patient data exchange, especially when the public has been assured that such information is protected under the Health Insurance Portability and Accountability Act (HIPAA). It also flies in the face of a global trend, according to Dr. Marty Kohn, chief medical scientist for care delivery systems for IBM Research, who endorsed the idea of patients controlling their data. Kohn made it clear he was speaking for himself, not for IBM, but noted there is a global trend toward patients controlling their medical records.
“It’s their information, they should be entitled to it,” he stated. “There might be issues about the patient’s ability to understand the information, and that’s a challenge for us to provide the information in a way that is useful to them.”
Yasnoff believes a central repository would benefit EMR vendors like Epic because a health record bank can be built with a business model that essentially pays providers for information. It pays outpatient providers to make deposits in a health record bank, and thereby pays for their electronic health record systems. “Clearly, if providers have a source of income from data produced by an electronic health record system, that pays for the system, thereby making their net cost for the system zero, the adoption rate of providers is going to be much, much higher than it is now,” he stated. “It’s clear from the high-tech incentives that providers are substantially influenced by financial considerations when acquiring EMRs, but the high-tech incentives ultimately are one-time only. They are over several years, and then they disappear.
“What we’re talking about in a health record bank is permanent incentives that would permanently offset the cost of electronic health records for outpatient physicians.”