I did not attend the Healthcare Information and Management Systems Society annual meeting this year, but I heard about many exciting developments that came out of the conference. One that stands out is a speech given by Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma. She spoke about how CMS is rethinking data management and patient care.
Verma started off by summarizing major advancements in the health care field and how digital health is revolutionizing medicine. But even still, she said, "Last year, CMS released a report showing that the rate of growth in health care spending is not slowing down. Despite all of the changes and regulations over the past decade, health care continues to grow more quickly than the overall economy. By 2026, we will be spending 1 in every 5 dollars on health care." With rising costs, how do we reduce spending without co-opting care? How can technology be a source of aid?
Verma said that President Donald J. Trump wants to reduce costs. To do this, patients must be involved in their own health care, she said.
"I've always been struck by how seldom the patient is mentioned in discussions around value-based care," Verma said. "Let me be clear: We will not achieve value-based care until we put the patient at the center of our health care system. Until patients can make their own decisions based on quality and value, health care costs will continue to grow at an unsustainable rate. This administration is dedicated to putting patients first, to be empowered consumers of health care that have the information they need to be engaged and active decision-makers in their care. Through this empowerment, there will be a competitive advantage for providers that deliver coordinated, quality care, at the best value, to attract patients who are shopping for value."
Of course, many pharmacists are aware of patients looking to find cheaper drugs online through companies, such as Blink Health and GoodRx.
But technology has changed our consumer mindset, and there has been a mantra recently regarding the fact that many people are questioning why health care cannot be more like retail. How much does a procedure cost? Who has the best ratings? As Verma said, "In every other area of our lives, we are receiving better services that leverage innovation in technology. We can take our ATM card to any bank across the globe, and that bank can access our accounts. We can track every credit card purchase, and every phone carrier honors our cell phone number, and we receive ads for products we were only thinking about buying, or so it may seem ... So, it should be no surprise that Americans have the same consumer friendly demands for health care. Americans are demanding that when they go to the doctor, the doctor spends more time with them and less time on paperwork or typing into a computer."
This is the bottom line of what future developments are coming down the pipeline, for good or for bad, depending on your take on health care. Applying a consumer mindset to health care is a drastic change, but in many respects, it cuts down on patient paternalism. Giving patients more access to health information and resources to make their own choices is challenging, and many health care professionals fear this, because they often think that patients cannot take on this responsibility. But, we are increasingly entering an era where patients have online access to their health information and records, which will help them make their own analysis and decisions.
Indeed, electronic health records are probably the biggest linchpin of a consumer model for health care, whereby those data are key to many companies looking to make a profit, such as Apple with its new operating system having access to EHR data on a patient's smartphone. However, with data so fragmented across so many systems, it is hard for patients to get information and share it easily. Interoperability is the next step.
Verma hit the nail on the head when she said " ... tremendous progress has been made in the adoption of EHRs. The technology for data sharing has advanced, and data is often shared effectively within a given health care system, with inpatient and outpatient doctors in the same provider system able to share and edit the same clinical record." But, "Despite this progress, it is extremely rare for different provider systems to be able to share data. In most cases there is not yet a business case for doing that. It's in the financial interest of the provider systems to hold on to the data for their patients," Verma said.
Hence, the MyHeathEData initiative, which aims to have data be shared across systems. Companies and organizations that make it difficult for patients to get these data will be penalized. This initiative will pave the way for consumers to have access to their own data, share it with anyone, and empower them to make their own health decisions.
With this ability, Verma hopes that medical errors will occur less frequently. "When providers don't have timely patient information readily available, tests are repeated, and we are paying for unnecessary treatments. All of this drives up costs and puts patient safety and quality of care at risk," Verma said. Taking this into consideration, pharmacists are perhaps 1 of the major health professions outside the stream of patient data access, which puts a damper on what we can analyze and do. I hope that this initiative takes our profession into consideration.
Data need to be shared in a format that bypasses old technology.
"Providers also continue to find it difficult and burdensome to use EHRs," Verma said. "They talk about how they are still using faxes to send and receive patient data. That's right: fax machines! In the era of artificial intelligence, machine learning and precision medicine, fax machines continue to be the go-to technology for providers transmitting health information."
This could be an indicator that pharmacies may see the era of fax machines come to an end soon and that there will be possible alternatives for data communication. If so, we can expect companies to start trying to sell this service or retail establishments start building them into their pharmacy management systems.
This just all leads to cost savings at the end of the day for CMS.
"So, let's be clear," Verma said. "We cannot effectively transition to a value-based system unless we provide to both the doctor and the patient all of the clinical and payment data required at the point of care, to help them mutually make a different and better decision than they could have today."
Companies that fail to adhere to this initiative and change are in trouble. Perhaps the most significant warning Verma gave was as follows: "And now, I call on all insurers to do as we have done today and give patients their claims data electronically. Over the course of the year, we will be re-examining all of our partnerships and relationships with health insurers to find ways to make it clear that we are serious about putting patients first and giving them control of their records, not merely in words but in deed. However, for those of you that still subscribe to the outdated idea that you can deny patients' access to their health records, I encourage you, in the strongest way, to change course and accept that those practices will come to an end."
What this means for pharmacists I think, while not directly mentioned, covers several areas that have been a big push for the profession in the past few years and things that we have wanted. Kill the fax machines first, and find a means to transmit data quickly that everyone can access. Things like medication reconciliation programs may no longer be needed, as we will eventually get to a point where medication lists are updated in real time across hospital organizations and pharmacies. Finally, we may finally be able to see patient data in the pharmacy. Let's be honest, it is hard to make recommendations and therapeutic decisions when we lack objective data, such as lab and test results, and this makes our recommendations or insights less meaningful for most clinicians with nothing substantial to back it up. This could change. So, who knows, major changes are in the pipeline, and we may see some significant benefits soon.
Remarks by CMS Administrator Seema Verma at the HIMSS18 Conference. CMS.gov. cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2018-Press-releases-items/2018-03-06-2.html. March 6, 2018.