Interoperability and Tech: Death of the Small Practice

Janae Sharp
AUGUST 31, 2018
small practice tech,community physician interoperability,physician practice ehr,hca news

When patients have their healthcare data, they receive better care.

The simplest data exchange can look like this: After a trip to the emergency room, a patient sees a specialist. For the visit to be most useful, it’s important for the provider to have access to the results of any tests performed in the hospital. The first thing a specialist would likely do is order more tests — but often, due to incomplete data exchange, these tests end up duplicating procedures that have already occurred.

>> READ: Inadequate Health Records Are Failing Mothers and Providers

That is one way how the lack of data exchange drives up healthcare costs and creates unnecessary delays in care delivery. Interoperability — the state in which data can be transmitted electronically and understood by different users, from providers to patients — could help change that, but many obstacles stand in the way. (The 2018 comment period for interoperability is open, and physicians and health system leaders should share their experience with how technical burden affects their practice.)

Despite clear benefits for patients, patient data are not readily accessible to providers who didn’t order the original tests or those who are working outside a large health system.  Many challenges exist, and when added up, it certainly seems like small practices are most at risk.

Obstacles to Interoperability

A lack of consistent coding is the first obstacle of interoperability. Many criticize electronic health record (EHR) companies for holding on to data (EHR orgs have a reputation for blocking health data exchange), or vendors for decreasing security through data breaches. Sometimes, the problem even affects different departments within the same health system.

One difficulty in incentivizing interoperability is that healthcare data have become a commodity. In July, 23andMe entered into an agreement to share genetic data with GlaxoSmithKline for a $300 million stake. When health data are seen as a competitive advantage, interoperability efforts are discouraged.

Another financial disincentive for data sharing is fee-for-service reimbursement. If a health system or provider is paid based on each test they order, then they financially benefit from testing. Regulations wherein financial incentives don’t align increase the divide between the haves and have-nots in terms of healthcare market consolidation.

A challenge facing interoperability regulations is that many see them as the death of the small physician’s practice. Regulations encouraging better data exchange are also driving up costs for small practices. Healthcare systems with money to develop better technology are buying up smaller practices and hospital systems, and interoperability standards can increase this divide. According to a Deloitte report, only 50 percent of today’s healthcare systems will exist in 10 years. The rest will be purchased and integrated into these larger systems. The cost of compliance is onerous, and many smaller practices (with already-overburdened physicians and staff) simply do not have the the bandwidth to add technology and new workflows.

>> READ: Rage Against the Machines

I asked Corinne Proctor Boudreau, senior marketing solutions manager at MEDITECH, what an EHR company would say about technical complexity and how it impacted small practices. She pointed to the increase in regulations and the burnout physicians are facing.

“EHRs and interoperability are major contributors to the shift away from small private practices towards healthcare organization employment. Inefficiencies in workflow in both areas increase time spent and burnout rates for physicians, but there is the technical knowledge and staff needed to support EHRs,” Boudreau explained.

She cited other factors, as well: “Twenty to thirty years ago, the core competency of small practices was practicing medicine with little administrative overhead or requirements. Today, medicine and patient care are more complex. In addition, administrative requirements of payers have skyrocketed, not just the actual work, but also being knowledgeable about all of the different demands, undergoing audits and understanding all the analytics and staffing models as the industry moves from fee-for-service to value-based care.”

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