Monday, November 23, 2009

Marketing Interoperability

In the past, it's been challenging to market interoperability because incentives to share data between organizations are often not aligned.

You can imagine the following conversation

"Hi - I'm from your local health information exchange. You may know that over 20% of lab and radiology tests ordered in our state are redundant and unnecessary. We're solving that problem through interoperability and we need you to invest $300,000 in capital plus $100,000 per year to connect to our state wide exchange. When it's all working, we'll eliminate all the redundancy, reducing your lab and radiology income by 20%. "

Interoperability is great for patients, a benefit to society, but can create a loss of income for some stakeholders. How do we sell it?

1. Health Reform - if healthcare reform aligns incentives for wellness and care coordination, stakeholders will be incentivized to share data. For example, if medical error is no longer reimbursed and hospital readmissions become a cost rather than a profit center, care summaries are likely to be shared among providers and data sharing between patients and providers will be used for home monitoring and keeping patients out of the hospital.

2. Meaningful Use Metrics/Pay for Performance

The HIT Policy Committee has proposed 29 metrics for 2011 - 17 measures of quality and 12 measures of meaningful use. Although the definition of meaningful use will not be published until next month, It is likely that clinical summary data exchange between organizations, e-prescribing, electronic laboratory workflow, quality measurement, and public health will be included. Thus, for organizations to claim their stimulus funds, they must be interoperable. Exchanging data between facilities within an organization does not count, per Dr. Blumenthal's recent newsletter. Many private insurers also ofter pay for performance incentives for reduced readmission rates, appropriate testing, and medication management. The combination of stimulus funds, Medicare Part D funds, and private insurer pay for performance should provide a reasonable incentives.

3. Peer pressure

I've seen several types of interoperability "peer pressure" in our communities. Primary Care physicians would rather work with specialists who can exchange clinical data, ensuring a closed loop referral workflow. Specialists who are not interoperable are likely to experience a decline in business. Among hospitals, our local CEOs have decided that healthcare IT should not be be considered a competitive asset for any one organization, it should raise the bar for all organizations to improve the health of the population. Thus, each CEO had decided to eliminate silos and share clinical summaries at transitions of care, even if this means exchanging data between competitive organizations.

4. Cost avoidance

The NEHEN network has eliminated paper for 90% of the administration transactions in Massachusetts, taking the cost of claims submission from $2.50 to .25 . We've been able to make the ROI/business case for funding interoperability operations based on cost avoidance. Clinical data exchange also has cost avoidance. ePrescribing eliminates the need for staff to process refills and reduces calls/pages to clarify prescriptions. Malpractice assertions are less likely when care is coordinated among patients and provides. Disease management programs administered by payers and case management activities are more efficient when data is shared electronically.

5. Increased business

Providing interoperable connections in and out of an organization should make that organization a more attractive business partner for clinical collaboration, clinical research, and diagnostic services. I recently was asked to enable data sharing between BIDMC and a business partner. I was told that interoperability was a significant value add to the relationship.

Thus, although there may be a short term misalignment of incentives caused by reducing redundancy and waste, the are many reasons to implementation interoperability for the long term. With new regulations and healthcare reform on the horizon, I'm hoping it becomes a business imperative!


Dodele said...

You referred to Dr. Blumenthal's newsletter...can you provide a link or let us know how to access it?

Re interoperability within an "organization" not counting for meaningful use, how is "organization" defined?

Don Livsey said...

The time has come. Last week we had a Alameda/Contra Costa (SF Bay Area) HIE stakeholders meeting. Representatives from John Muir, Children's Oakland, Sutter, Kaiser, St Rose, Alameda Hospital Washington Hospital, Both County's health and hospital services, Hill Physicians, Muir IPA, and others. Governance and Planning committees are forming. At some level we're all competitors but this is far too important to let that stand in the way.

John Halamka said...

I've added the link to Dr. Blumenthal's update in my blog