What's in store for 'the next generation' of health IT? Moving to value-based systems

As more providers and payers transition to value-based care, breaking down IT system barriers such as lack of interoperability and incomplete data standards will be at the forefront of the agenda for "the next generation" of health IT, according to Thomas Feeley, MD, Zachary Landman, MD, and Michael Porter, PhD.

In the "the Agenda for the Next Generation of Health Care Information Technology," published in the May/June 2020 issue of NEJM Catalyst Innovations in Care Delivery, Drs. Feeley, Landman and Porter explain that health IT stakeholders must make various changes to successfully transition to value-based care, including supporting data exchange between EHRs and other systems. The strategic agenda for moving to value-based delivery, according to the co-authors, relies on: organizing care around medical conditions, measuring outcomes and costs for every patient, moving to bundled payments for care cycles and integrating care-delivery systems and geographically expanding centers of excellence.

"The field of IT has put forward concepts such as big data, advanced analytics, and learning systems that are frequently mentioned as 'solutions' that will transform healthcare," the co-authors wrote. "However, such concepts are far ahead of today's EHR capabilities and current care-organizational models. While EHR systems, in theory, have the ability to dynamically collect, store, analyze, and transmit seemingly unending amounts of information, current systems are not structured to adequately accomplish these functions, much less capture care processes, outcomes, or true costs by condition."  

To address these EHR and IT systems barriers and achieve the next generation of health IT, the co-authors laid out steps for vendors, providers, patients and public policy. 

1. Vendors must be proactive in supporting value-based care and incorporate outcome measurement and management abilities into their systems as well as expand their revenue cycle tools beyond fee-for-service reimbursement and create tools that support value-based models such as bundles and capitation.

2. Physicians and provider organizations must demand interoperability for all IT systems in order to support the development of value-oriented care networks. They must demand that vendors create user-friendlier computer interfaces and vendors provide systems that can collect and report value-based measurements such as transparent outcomes and costs of care.

3. Patients should apply the same demand ratings of providers that they do of retail products, transportation, dining and accommodation industries. They must demand full electronic access to their health records, full disclosures of clinician records of care outcomes for certain conditions and a transparent estimate of out-of-pocket costs.

4. Private payers could insist that IT systems accommodate for outcome and cost measurements. If payers were to insist on only paying for good outcomes, it would require the collection of standardized outcome measures using an IT system that is value-oriented.

5. Health IT public policy can speed up the shift to value-based IT systems by implementing regulations that focus on seamless data extraction and interoperability, standardized outcomes measurement and improved IT use for mental healthcare.

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