Health Reform Dependent on Good Information Technology, Says Abby Sears

Change may not happen at the speed stakeholders anticipate, she says – but being willing to learn from mistakes will be helpful

February 4, 2013 -- Healthcare reform – at both the state and federal level – won't be possible unless clinics and providers have good, up-to-date information on their patients. That in turn won't be possible without good information technology and appropriate supports, said Abigail Sears, CEO of the Oregon Community Health Information Network.

OCHIN was founded in 2000 by a group of community health centers to work on their behalf to purchase and service information technology products. While providing IT support is the core of what
the nonprofit does, it's expanded operations to work with 33 clinics in Oregon, as well as with clinics in nine other states.
 
Now the organization is focused on building and supporting software tools to help assist clinics with healthcare transformation, with a focus on aggregating patient data so that it's up-to-date and provides information that can be useful to providers. Not only is there a lag time of several months before providers can access information recorded in insurance claims, those records don't tell the whole story, Sears said.
 
“Claims data only tells you what they billed [the insurer] for,” and that isn't necessarily reflective of everything that happened in a visit, Sears said. In Oregon, coordinated care organizations have been created with the specific task of reducing Medicaid spending growth while improving care – and determining whether the state has met both of those goals is going to depend on having good clinical data which details not just what the provider was able to bill for but what actually happened during the visit, including conversations with nurses or social workers.
 
That information is often recorded in electronic medical records like those used by Kaiser – and there can be an enormous gap between what's recorded in those records versus what's in claims data. Sears said a research project run by OCHIN, comparing electronic medical records with claims data for patients with diabetes, found a 20 to 60 percent gap between the claims data and the medical records.
 
Sears said she hopes OCHIN will have a role in assisting coordinated care organizations with aggregating data so it's useful to them. Since the organizations are so new and so heterogeneous – with some being formed from scratch and others being created by health plans – it is likely to take a while before organizations even know what they need in terms of data aggregation.
 
“I think they're not really in a place where they know what they need. They don't know what they don't know,” she said. While state and federal reforms aim to break down traditional “silos” and integrate different disciplines – including social services and epidemiology – into the mix, each discipline has its own vocabulary.
 
Even IT staff who specialize in healthcare speak a slightly different language than healthcare providers, and both disciplines are changing so fast that communication can get confusing quickly. Sears said OCHIN is emphasizing – and, at the state level, advocating for – better training of IT professionals to
make them less specialized. Epidemiologists need to learn to program, and programmers need to learn how to process biostatistics, she added.
 
While Sears is concerned about some of the technological hurdles to transforming care at the state and local level, she's optimistic about how Oregon's unique political character can effect changes.
“I think we're a state of innovation,” she said, noting that while aggregating and analyzing the data is a challenge, healthcare systems in Oregon have been quicker to adopt electronic medical records than in other states.
 
Sears also said she’s concerned that the state may not be able to meet transformation goals in the timeline it's being tasked with. Change, she said, takes more time than that.
 
"I think we're on a 10-year path. I think we'll make great progress in three,” Sears said. “There will be mistakes. As long as they don't think there's an answer and somebody just wasn't smart enough to get it, but we're willing to look at what happened and learn from it, it will be OK.”
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