Guest post by Motient co-founder Dr. Richard Watson
Amid the transition to electronic health records, the rise of the virtual patient, the never-ending push for data gathering at every interface, and a hardware and software explosion, the fax machine lives on. A good friend of mine, who is now the product owner at Motient, first joined the team as we were surveying facilities to assess their patient movement needs. Somewhat new to the environment, he was a quick study; after just a few visits, he made the astute observation that “Healthcare is solely responsible for keeping the fax industry alive!”
As of 2019, approximately 90% of healthcare providers still rely on faxes, a phenomenon that has prompted a recommendation to end all fax usage by 2020. Today, while the percentage of facilities using faxes is elusive, estimates put it at above 75%.
The Rise of EHR
Healthcare as a whole has not been a rapid adopter of the digital revolution. We all remember the MS-DOS green screen that was a mainstay of the nurse’s station while the rest of the world was well into advanced graphics. Yet there are exceptions. As an example of how our inertia can quickly be upended, let’s look at the rise of the electronic health record (EHR) system.
In 2005, a Rand study claimed that EHR systems could potentially save healthcare $77 billion per year through optimized resource utilization, along with providing a seemingly endless list of patient care advantages. Fueled by that study, Congress passed the 2009 American Recovery and Reinvestment Act, which supplied $35 billion to support the “meaningful use” of EHRs, words we have come to know well. With the creative use of reimbursement withholding, adoption came quickly; 13 years later, more than 90% of facilities use EHRs.
Obviously, that much money creates new leaders in the industry. Epic and Cerner took advantage of the moment to move into multi-billion-dollar positions. They became household names, and with the stroke of the legislative pen, an entirely new billion-dollar healthcare expense line was born. As is true of most top-down initiatives, healthcare organizations did not realize the promised results. Costs were higher and savings lower than expected, and the EHR quickly evolved into a very efficient billing machine with little utility as a clinical tool. As EHRs are now loaded with inaccurate data and plagued with inconsistent application, the lack of standardization has become a sinkhole for precious healthcare dollars. EHRs require a constant influx of cash to assure security; review, clean and purge data; and integrate other non-standardized data into the new system of record.
As the two dominant players, Cerner and Epic have chosen two different paths. Epic continues to be insular, with even its own versions not playing well together. The company’s refusal to move toward any data compatibility hampers usability. While Epic Anywhere gives access to others in the club, the company’s protectionist philosophy stymies the industry. As the second most popular EHR, Cerner has scrambled to adapt an interface that is clearly inferior to Epic’s. Cerner’s recent sale to Oracle for $28 billion indicates where this market is headed. Oracle’s public business plan says it will integrate disparate data sources into a cloud-based solution as the company attempts to leapfrog over Epic.
I am dated enough to remember VHS and Betamax. With its name brand, national footprint, and arguably better format, Sony decided not to play with others. As VHS quickly found its way into the market through a wide variety of brands, the format became ubiquitous — not because of its quality, but due to its availability and price point. We’ll see if the analogy plays out.
The evolution of healthcare data also reminds me of how photography has changed. Film, the dominant player, ends up in boxes in an attic with no reference point other than quality, context, and our memories of the captured moment. Any effort to organize one’s pictures required a Herculean effort. Once the digital age struck, those boxes simply moved to file folders collated by date. Fortunately, software can now group them by location, content, and even person. We have programs capable of cleaning up files and reducing redundancy. Video was once 8-millimeter, then Super 8, then digital. All formats created a constant flow of images that ended up in boxes and then files, which were even more challenging to categorize and collate.
Finding the Best Way Forward in the Digital Healthcare Revolution
Healthcare data is following a similar course. While healthcare systems are already struggling with the usability and interconnectedness of their data, here come the wearables: small devices that can harvest an almost endless number of parameters. There are so many companies trying to solve the problem of integration and usability for this endless stream of data that there is almost a festival atmosphere for investment firms. Which are the best short-term and long-term plays? Which company will win the golden prize? In all likelihood, information brokers such as Google and Oracle will develop a platform that will level the playing field. EHR specificity will diminish and become a commodity.
At a more granular level, there are a few realities that should be recognized in the next few years of the digital healthcare revolution:
- Healthcare billing and clinical data demands need to be separated. While they draw on similar elements, the format of clinical data collection must move away from checking boxes for reimbursement. Macros are now a large part of the current record, which does not represent the true clinical experience; macros are simply a reimbursement multiplier. Cut and paste elements have ballooned medical records to the point of being unusable.
- Healthcare data needs to be stratified. Categorizing data based on verification, validity, accuracy, and usability is absolutely necessary. The heart rate data from my Garmin watch and the most complex surgical videos are worlds apart; they should be treated as such.
- The industry needs to be comfortable with not collecting every piece of data possible. Instead, we must be willing to distill the problem down to the necessary elements. Inaccurate and conflicting “data fat” hinders every system; unchecked, it’s a killer.
At this point in the digital healthcare revolution, the deck will soon be reshuffled. Big players will set the rules for the playing field, but the market will ultimately decide what products are most usable. Reimbursement will either hinder the process or propel this reshuffling onward. To find elegant solutions to basic problems that actually require solutions, nimble companies will need to carefully pick and choose which data elements are essential to their function, limiting their scope to solving specific problems. Integrating these precise solutions into our current landscape will help show our industry the way forward.
- 90% Healthcare Providers Still Rely on Fax Machines, Posing Privacy Risk. Health IT Security. https://healthitsecurity.com/news/90-healthcare-providers-still-rely-on-fax-machines-posing-privacy-risk
- RAND Study Says Computerizing Medical Records Could Save $81 Billion Annually and Improve the Quality of Medical Care. https://www.rand.org/news/press/2005/09/14.html