At the World Health Care Congress 2016 in Washington D.C., Robb Walton, senior policy advisor to Sen. Bill Cassidy (R-LA), stressed the need to move away from measuring physicians' health IT progress through processes, but rather by outcomes.
On April 11, at the Marriott Wardman Park Hotel where the conference is being held, Walton was the fill-in keynote speaker for Sen. Cassidy, who had a family emergency he had to attend to in Louisiana. The presentation, "The Future of EHRs and Meaningful Use," began by outlining the complications that health IT brings onto physicians, but emphasizing the significance of keeping the focus on the patient-provider relationship. "We have gotten lost in the nuances of implementing health IT, but if we are not doing all this for the better of patient care, we are failing, Walton said.
As such, Walton referenced the goal of the feds' to get 50 percent of physicians into alternative payment models (APMs) by 2019, as well as the transformation currently happening through the Medicare Advantage program regarding hospitals taking on two-sided risk and being accountable for their patient populations. To this end, Walton identified the four keys to succeeding in value-based payment models: standardized performance measurement; transparency and public reporting; payment innovation; and informed consumer choice. He specifically emphasized the last key, informed consumer choice, as perhaps the most important one. "It's the ability to have an activated patient with knowledge, confidence, and the skills to participate in managing their healthcare," he said, using the example of his recently-bought FitBit that can have a profound affect on changing one's lifestyle habits. "This, in addition, to having doctors talking and educating patients in the office, is when you start the shift from sick care to preventative care," Walton said.
Robb Walton at World Health Care Congress 2016
Walton discussed the spectrum of value-based payment models in regards to the different types of patients—the ones in high deductible plans with health savings accounts, to the ones in the middle who pay a fee to go to primary care center without being rushed in and out, to the ones who are completely being taken care of by their healthcare system that takes on two-sided risk. No matter the type of patient, a robust EHR system is needed to measure quality and data accurately, and get insights into patients' behaviors that weren't possible even a few years ago, Walton said.
That being said, physicians are deeply frustrated with the current state of EHRs, Walton added. "Surveys show that they are the leading cause of physician dissatisfaction. Many doctors say they are not worth it and that patient care is worse since the meaningful use program was [launched]. They spend less time in direct patient care than they do in clicking boxes on computers," he said. "If money is time, we are clearly spending way too much of it on the burden of documenting and clicking boxes. "Physicians should not be clerks, they are trained to take care of patients."
Indeed, there is a need to change the regulatory structure of EHRs in order to get physician buy in, Walton said, telling a story of when Sen. Cassidy ran into a doctor who runs a post-acute hospital in Mississippi. Since post-acute providers don't participate in meaningful use, this particular organization developed its own EHR system from the ground up in consultation with physician practitioners. Leaders at the organization were able to focus specifically on physicians' clinical workflows as opposed to being constrained to meaningful use regulations, Walton explained. "And they have outstanding results; their EHR is faster than paper, which is unprecedented in healthcare," he said. "It focuses on usability, so there is enormous physician satisfaction. They are dictating their notes as opposed to checking boxes. We need the government to readjust their criteria to focus on outcomes rather than processes."
Walton brought up the Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act of 2015 from Cassidy and Sen. Sheldon Whitehouse (D-R.I.), an effort introduced to start to make this paradigm shift towards outcomes and away from processes, he said. The bill's aim is to help ensure that certified health IT systems are performing as promised in the field, and establish a rating system that will enable consumers to compare different products based on that performance.
"We wanted a stakeholder-driven process, so we focused on three areas: usability, interoperability, and security. It will completely focus on outcomes in the field as opposed to processes in the lab. Stakeholders will develop outcomes-based criteria to see if the EHR is usable in the field for physicians. Is it interoperable in the field?" Walton said that Cassidy and his senior leadership define interoperability as the ability of the user to get information they need when they need it for the purpose intended. "Transferring information from one EHR to another is great, but what about Facebook? Walton asked. "When you view your pictures on Facebook, you don't download them, but you go into another system or server and view them. You have to be cautious to not inhibit innovation in the future," he said.