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Leveraging IT Solutions to Support Integrated Care Interestingly, results of the 2012 Health Information Technology Survey (HIT Survey) – sponsored by CMSA, TCS Healthcare Technologies, the American Board of Quality Assurance and Utilization Review Physicians, and other health care organizations – also indicate an increased reliance on IT systems to support the storage and flow of health care data processed across clinical settings. Trend Report #6: IT Infrastructure, which is being published this month, focuses on key IT framework and integration issues based on survey participant feedback, including issues with: IT integration, electronic linkage, software sourcing, claims integration, and care management IT system hosting. The survey questions were broad enough to cover a wide range of IT systems, including EMR, care management, claims, and general medical management software. Here are some highlights from Trend Report #6: Integration About one quarter of respondents (23 percent) in the 2012 survey claim their information technology systems are fully integrated and interoperable with other external IT applications. The survey results for this question represent a 3 percent increase since the study was first conducted, up from 20 percent in 2008, but the same as the 2010 survey results. With all of the public policy and private sector initiatives underway, one would have hoped for more progress in this area. One mitigating factor, however, could be that many providers and health care businesses are still implementing new IT systems. This might be a case where organizations may need to take one step backward in order to take two steps forward. Moving to a Paperless Office Not surprisingly, the HIT Survey reveals an increased reliance on IT systems as more organizations move to a paperless office environment. Of the 2012 respondents, 30 percent state their "office has moved to a completely paperless environment regarding patient or care management," up from 17 percent in 2008 and 23 percent in 2010. Further, the number of respondents that can "scan medical records, documents, and/or communications into (their) medical management information systems" has increased to 63 percent, up from 40 percent in 2008 and 54 percent in 2010. While this statistic represents one of the most significant gains in the survey series, scanning is just one example of moving to a more integrated approach to care. Scanning documents reduces paper files, but – in the absence of character/word recognition technology – these records are akin to photographs in most cases, and are not easily quantifiable for outcomes and reporting purposes. However, technology is now being introduced in the marketplace that will promote "semantic" searches, much like Google indexes documents. Electronic Linkage Challenges In all three surveys, participants were asked about electronic linkage of their systems. Contrary to what may have been expected from the slightly increasing electronic linkage trends between 2008 and 2010, the 2012 survey revealed a rather dramatic drop in the electronic linking of clinical practice or medical management data with various other systems and data sources. In all categories, there was an overall decline between the linkage reported in 2008 and 2012. Some of the biggest drops were seen in claims payment data (20-point decrease) and pharmacy claims (13-point decrease). A similar trend was found in the reduction of linkage to consumer health information from 2010 to 2012 (12-point decrease). Further study would be helpful in order to determine whether these downward trends are a result of question bias between the three Health IT surveys, as opposed to an actual market trend shifting away from electronic linkages. The shift away from integration across different systems could be related in part to privacy and security concerns, the growth of provider-based organizations such accountable care organizations (ACOs), or the expansion of health IT applications, thereby creating a short-term effect of less connectivity to existing IT systems. It is also possible that these decreasing trends could be due to greater input from provider organizations in 2012, which may not have the level of integration that health plans, MCOs, and TPAs already have. Software Source Similar to 2010, the 2012 responses are divided fairly evenly between in-house developed versus vendor-purchased medical management systems (both 26 percent). There was also a sizable hybrid approach (20 percent) reported. The use of vendor and hybrid solutions remained relatively stable, with a change of only one percent. In comparison to 2008, the use of systems developed in-house has increased by seven points. Although the reasons for this are not clearly understood, there may be a cost sensitivity factor in play. Final Thoughts While the overall results show that trends are steadily moving in the direction of increasing reliance on IT systems – which support the storage and flow of health data in massive amounts, processed through various clinical settings – these systems are not as well-integrated as might be expected. In fact, several health IT survey question results seem to indicate the opposite trend: that IT systems and data sources have actually become less linked in recent years. Once the adoption of electronic health IT systems is fully realized, case managers should benefit from automated workflows, streamlined, and standardized processes, enhanced communication among the health care team to provide better transitions of care, and improved outcomes and quality of care. To access the Trend Report series, please click here. [1] The Institute of Health Technology Transformation Population Health Management: A Roadmap for Provider-Based Automation in a New Era of Healthcare, http://ihealthtran.com/pdf/PHMReport.pdf
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