The process has been slow, cumbersome, and far from complete, but much progress has been made. Lawrence S Friedman MD, Associate Dean for Clinical Affairs at University of California San Diego (UCSD) Health Sciences, discussed the four cornerstones responsible for the escalation of digital adoption in healthcare over the past decade in a presentation at the conhIT 2018 conference in April. Those fundamental foundations are:
- federal government regulation and financial support;
- the need for transparent and rapidly accessible patient records;
- the necessity of ‘big data’ to quantitatively improve healthcare treatment and quality, and
- the transition of the USA’s healthcare providers from a volume-based to a value-based economic model.
These factors are reliant on the success of each other, escalating the importance and impact of digitisation, Dr Friedman explained during our European Hospital interview.
Federal government involvement: A ‘carrot and stick’ approach
With the signing of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, President Barak Obama changed the face of healthcare. The legislation provided financial incentives for providers to implement health information technologies and financial penalties for those who did not. The Office of the National Coordinator for Health Information Technology reports that, in 2008, only 9% of hospitals and 17% of physicians utilised an electronic health record (EHR). By 2015, this had increased to 96% of hospital and 78% of physician offices.
Transparency of patient data
Being able to compare specific treatments with outcomes has had a major impact on mandating and monitoring improvements in healthcare qualityLawrence S. Friedman
The digitisation of patient records and the integration of EMRs with specialised data acquisition systems, such as for laboratory and radiology tests, meant that, to become fully comprehensive, EHRs had to create transparency of patient data that paper-based records could never accomplish. In addition to rapidly providing clinical data to clinicians who needed it, healthcare managers could now evaluate performance criteria, treatment outcomes, and the effectiveness of quality initiatives. Deficiencies could be identified and their impact quantified, and rectification measures could be monitored in real-time. Standard-of-care guidelines could be tracked as well as follow-through relating to treatment. And, for the first time, patients could access their own medical records. These and dozens of other applications suddenly became possible and economically feasible.
‘Being able to compare specific treatments with outcomes has had a major impact on mandating and monitoring improvements in healthcare quality,’ Friedman said. ‘As examples, both the Integrated Healthcare Association and the Office for the Patient Advocate in California track and publicly report an array of quality measures by medical group, ranking them according to performance. These reports are readily available to patients, health plans, and providers,’
Big Data/Deep Learning/AI
The acquisition and availability of data from many sources, combined with radical improvements in IT technology, have led to the utilisation of ‘big data’ for analysis. ‘Without EHR data, evidence-based healthcare initiatives would not be possible,’ Friedman noted. ‘Deep learning, precision medicine, and artificial intelligence (AI) have developed as a result of EHR, and now are expanding applications in healthcare at a dizzying rate.’
The medical campuses of the University of California (UC) at San Diego, Davis, Irvine, Los Angeles, and San Francisco aggregate data. Sophisticated software analysis systems are now using deep learning/AI to identify the best treatment outcomes for patients with specific diseases/conditions – and drilling deeper – specific symptoms. These initiatives may be in their earliest stages, but Friedman expects the technology to revolutionise evidence-based individualised medical care, making the work of a physician more accurate and efficient – and less costly.
Volume- to value-based financial compensation
The USA’s healthcare system is notorious for its costly, often ineffective and inefficient volume-based payment model. The accountable care mandate imposed by the federal government is forcing a change to value-based care. Put simply, instead of being paid for the number of treatments and services performed, providers are being incentivised to keep patients healthy and out of physician offices and hospitals.
Quality of treatment is now being prioritised over quantity of treatments. With digitisation, the performance of providers can be compared to any standard. The national goal is to reduce healthcare costs while improving the health of a nation and while optimising its healthcare-related resources.
Dr Lawrence S Friedman is a professor of medicine and the associate dean for clinical affairs at University of California San Diego (UCSD). A primary care paediatric specialist, he was one of four physicians involved in the evaluation and implementation of the hospital’s EHR system. He also led the initiative to establish a state-wide telemedicine program for patients and providers and is an enthusiast about promoting how digitisation can transform healthcare.