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Will the Federal Government’s Newly “Aggressive” Agenda Bring True Lab Results-Based Interoperability?

March 13, 2013
by Mark Hagland
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Robin Raiford believes that one element in the federal healthcare agenda for 2013 could dramatically improve patient care delivery

Yes, definitely. For one thing, you could begin to analyze lab results more broadly, across whole communities and regions. For example, with lab values coded in LOINC-based format, you could trend information on an individual lab tests on specific patients, and could trend that information more broadly and determine whether a particular disease outbreak trend is going up or down. And Farzad was very clear during the town hall last Thursday; he said over and over again, we’re going to use every policy lever we have. And in the HHS announcement, they had mentioned the lab as well. The lab piece is mentioned in question number 10 in the RFI [the request for information that Ms. Tavenner and Dr. Mostashari announced that on March 6 the government was sending out to the industry--see p. 15 of the RFI here, which discusses the potential for direct patient access to lab results based on modifications to the CLIA regulations].

It seems that the implications for improving patient care might be very broad, if LOINC-based lab results communications could flow automatically into EHRs.

Yes, because right now, hospitals and EPs [eligible providers under the HITECH Act] are required to include patient problems, meds and allergies in EHRs. And problem lists, medications, and allergies are all very important information. But the ready availability of patients’ baseline lab results are the keys to the kingdom.

Overall, is it your feeling that federal officials including Ms. Tavenner and Dr. Mostashari are pushing down at about the right level on the levers of their power and influence to compel change in healthcare?

I do think they are, yes. I think they need to push [healthcare reform and meaningful use], because people don’t just do this on their own. There was a very interesting documentary on CNN last night about quality in healthcare. That documentary looked at some of the issues around both cost and quality in healthcare. What’s clear is that people need to be pushed to change healthcare for the better, because we’ll be bankrupted otherwise. And before the election, President Obama said, the purpose of government is to get people to do things they could not do on their own; and I would add, the purpose is also to get people to do things they would not do on their own. And frankly, I think it’s appalling that some people are going to wait until the very last minute in 2014 to move forward on meaningful use. And I’m a big Obama fan, but I just think this is where healthcare has to go.

The plain reality is that when you have a set amount of money to take care of individuals, quality and prevention naturally come to the fore; I discovered this in doing some research on Indian/Native American healthcare delivery in Arizona and Alaska. In those situations, they’re working with limited funding, and yet they consistently deliver quality care. Another example of how healthcare delivery has to be reconsidered has to do with the most innovating healthcare organizations, many of which have salaried-physician models. For example, I didn’t know until recently that the doctors at the Cleveland Clinic were salaried; that’s their business model, and it really makes sense.

I also believe strongly in patient engagement, and recently made public comments to the HIT standards and policy committees around what can be done to engage patients. In those comments, I said that what’s needed is to create some kind of patient experience or excellence award; HealthGrades has just created a precedent for that, with their Outstanding Patient Experience Award recipients. What's particularly interesting is that, of the 311 recipients of that award, over 150 of them are also meaningful-user hospitals.

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