Eighty percent of the medical malpractice claims that drive up the cost of healthcare are caused by miscommunication between primary care doctors, specialists, labs, EMS providers and hospitals that don’t know what’s in each other’s electronic patient records.
And this has a significant impact on New Jersey employers, who pay the bulk of their employees’ health insurance premiums.
“You have employees and they get care in lots of different locations,” Laura McCrary, senior vice president of the malpractice insurer KaMMCO told a group of New Jersey business leaders at NJBIA’s Healthcare IT Summit on Wednesday. Patients “don’t go to the same doctor and the same hospital for all of their care and all those different places have different electronic health records. And unfortunately they don’t share each other’s separate electronic patient records.”
The challenge facing the healthcare industry today is “interoperability,” which is the industry’s term for making the various electronic data healthcare systems now in use “talk” to one another, McCrary said. Right now these electronic data systems are comparable to individual cellphones that can do wonderful things such as calculate numbers, take notes and snap photos, but are still unable to talk to one another because there is no network to connect the calls, McCrary said.
The goal is to create the infrastructure that allows the community doctors to connect with each other and communicate with the hospitals, the labs, and the specialty-care doctors in order to create a “longitudinal patient record available to all clinicians across the state,” McCrary said.
Employers will benefit because when doctors actually have a complete health history of their patients they’re going to be able to provide better, safer and lower-cost healthcare for employees, McCrary said.
The ability to share real-time clinical data, not just after-the-fact claims data, is also important to population health as the industry moves from the traditional fee-for-service reimbursement model to value-based models that focus on patient outcomes, according to the other industry leaders who participated in the NJBIA panel discussion on “The New Look of Healthcare Data.”
Horizon Blue Cross Blue Shield of New Jersey, the state’s largest insurer, has built its own private health information exchange with key partner providers because it is important to identify high-risk patients from a population health management standpoint in order to manage their healthcare delivery more effectively, said Douglas Blackwell, Horizon’s senior vice president and chief information officer.
Jim Cavanagh, the executive director of the New Jersey Health Information Network implementing the state’s IT strategy for healthcare, said the interoperability of electronic health data is essential as the industry moves from a fee-for-service reimbursement model to a fee-for-value model that pays physicians based on outcomes, not just on the number of tests and procedures that are performed.
“If you don’t have the data to measure quality, you really can’t show you’re providing quality care,” Cavanagh said. “Interoperability is where we need to be, but we’re not there yet.”
Cavanagh noted the NJ Health Information Network completed its pilot program and is moving to go live statewide.
“We already have great assets in New Jersey,” Cavanaugh said noting there are already existing health information exchanges, or HIEs, that are connecting 6 million patients. “What we need to do at the state level is not reinvent wheels, but connect the dots between the HIEs that are out there functioning already with the providers, with the payers, and get that information flowing in the right direction.”