While there is almost universal agreement on the need to transform our nation's healthcare system, few stakeholders agree on specific solutions. From pundits to politicians, everyone has recommendations on to how to fix healthcare, including expansion of access, increased individual responsibility, more competition, less competition, more government control or less government control.
One area of growing consensus, however, is that the information technology infrastructure underlying our healthcare system is woefully inadequate to the task of transformation. Evidence of this recognition was recently reinforced by the Obama White House and its inclusion of expanded funding for electronic medical records as part of the economic stimulus package.
In any case, healthcare transformation will require new models for sourcing, processing and distributing richer, more complex data in ways that facilitate collaboration, real-time decision-making and hands-free automation. Numerous obstacles lie on the path to real-time digital collaboration, however, including healthcare claims clearinghouses that remain the dominant electronic conduit among providers and payers.
In a 2004 Harvard Business Review article, "Redefining Competition in Healthcare," renowned strategy expert Michael Porter and innovation expert Elizabeth Teisberg argue that with the right kind of competition "the healthcare system can achieve stunning gains in quality and efficiency." The authors argue that relevant information is key to any well-functioning competitive market but is all but absent in our current healthcare system.
Imagine how an information-driven healthcare system might look and feel. Not only would consumers be better equipped to make informed decisions, but those decisions could influence other aspects of their healthcare experience, such as the cost of services or adjustable rate premiums.
In this information-rich environment, coaching and advisory services firms would emerge to guide consumers faced with making critical care decisions. Physicians would prescribe treatments based on the latest protocols and the patient's up-to-date longitudinal health record.
During recent years, vendors have leveraged their experience and assets to provide enhanced cleansing and transformation services to help payers achieve regulatory compliance at a fraction of the cost of internal development. These economics proved favorable as clearinghouses maintained their dominant position of connecting hundreds of payers with thousands of providers who lacked sufficient technology and know how.
Challenges extend well beyond technology, however, because of a business model that incentivizes exclusive relationships and controls the flow of critically important information. This situation is incompatible with the demands of today's consumer-directed health plans, incentive-based reimbursement models and the retail revolution for providers.
Valuable lessons that could be applied to healthcare transformation can be learned from other industries that have undergone similarly disruptive digital transformations. The advent of the Internet, supported by expanded availability of broadband services, gave fuel to the dot-com revolution of the 1990s. We have every reason to expect the same is possible in healthcare if the roadblocks of funding and common standards can be overcome.
The healthcare industry can gain insights from an examination of the changing IT landscape and its ability to increase efficiency, enhance quality and empower people to take responsibility and make informed decisions for themselves and their families. Why is it that healthcare seems unable to follow new business models based on today's information technology?
For the most part, middleware-based integration methods have proven too complicated and expensive for even the most sophisticated enterprises. Instead, a strategy of integrating disparate touch points at the transaction level, independent of user interfaces and technology preferences, is much more practical.
To achieve anything close to an integrated e-health transaction will require healthcare "transaction integrators," a new class of IT professionals whose skills and domain expertise extend far beyond electronic data interchange, messaging and networking.
Healthcare transaction integrators will possess specialized knowledge of emerging technology, business, healthcare, financial and regulatory standards. The transaction integration model emphasizes automation of virtually every element of the patient encounter life cycle from verification of coverage through real time settlement. The healthcare transaction integrator must understand the context in which these domains can be meshed to facilitate new processes.
Transformation of our healthcare delivery and support systems is an economic and social necessity. Digitization offers wondrous opportunities for greater access to better quality, lower cost care. Delivering on the promises of a 21st century healthcare system will, however, require new thinking, expertise and business models that facilitate collaboration among all participants.
Barry Byrd is president of Secure EDI, a healthcare information technology company. He can be reached at bbyrd@secureedi.com .
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