Interoperability and Tech: Death of the Small Practice

Janae Sharp
AUGUST 31, 2018

Technology and Interoperability Regulations Could Be the Death of the Small Physician Practice

Administrative complexity, including communicating with insurance companies, means the data exchange can be too much for a small physician’s practice, which might not have the technical talent or time to train its staff in the latest procedures for interoperability in data exchange and health record capabilities.

Seema Verma, M.P.H., administrator of the Centers for Medicare and Medicaid Services, has called for an end to faxes, but she has given little guidance on better workflow solutions for practices that rely on fax. Is there a convenient way to transfer data and coordinate with other practices? If sending a fax wasn’t the easiest solution, it wouldn’t be used.

Without a clear solution that creates easy data exchange within physicians’ existing workflow, this is not a useful call to action. One of the most important things that will influence the efficiency of care and the ability of providers to communicate will be the elimination of a system wherein doctors receive hundreds of pages of faxes each day. Despite criticism of faxes as a means of transmitting data between providers, no better solution appears on the horizon — at least not without significant added technological complexity and cost.

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This high cost is especially burdensome for small practices. Each provider pays a fee every year to belong to a health information service provider (HISP), and if the exchange doesn’t contain existing patient data, or not all providers have uploaded information into an exchange, members end up paying for the potential to have data exchange with no real value.

I spoke to Spencer Kubo, M.D., about his experience setting up data exchange for his smaller practice. He currently works for CareCognitics, a healthcare company created by casino technology experts to improve care coordination and loyalty. He said, “the incremental costs associated with developing and maintaining electronic health records could be the death of the small practice.”

“It’s astounding that you can do a banking transaction in Singapore or Zurich or Minneapolis or New York and everything is fine. You can purchase on four different continents with your credit card, and everyone understands what has happened. A hospital can be four blocks from a clinic, but because it is on a different [EHR] or a different health system, you cannot exchange information freely.” — Spencer Kubo, M.D.

In working with some EHRs in a practice setting, Kubo found that a small practice doesn’t always get responses from their EHR vendor about interoperability. After three years of effort to get approved, Kubo’s practice still faced the barrier of building and maintaining information systems. This technology cost can be untenable for smaller practices, which can go on to harm data-sharing networks

In a marketplace like Las Vegas, where smaller practices still exist and where Kubo lives, data exchange problems are even more apparent. These small practices have all the IT complexity challenges with none of the benefits. Don Lee, interoperability expert and producer of the HCBizShow, mentioned that a small practice or an independent physician simply does not have the bandwidth to deal with every type of regulation. Which of the following organizations does a small clinic need to comply with? CMS, DOH, BORM, BORN, TJC, NIST NISC, ISO, et al. If policymakers can’t keep track of all the regulations, how will an overburdened physician deal with data requirements?

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According to Dirk Stanley, M.D., M.P.H., chief medical information officer of UConn Health, the framework for compliance needs to be addressed. Complexity of data requirements within organizations can require a full-time data expert. “Add the insurance companies to that mix, and you need a whole team of people just to comply with everything you need to comply with,” he said.
Healthcare providers currently have to pay for many end-to-end point connections for data. The office of the National Coordinator for Health IT (ONC) has proposed a common “on-ramp” for data exchange. Don Rucker, M.D., the office’s head, has championed the idea of having a trusted exchange framework and common agreement (TEFCA) that will help address complexity in data transfer. Under this proposal, a small provider would not have to pay for each different connection. (The current review period for interoperability requirements for the ONC is open. Physician practices that have dealt with expensive data connections should comment here.)

Boudreau told me that small practices need “better systems and better technology” to decrease technical burden but also suggested that “if a practice lacks the bandwidth internally, some processes can be outsourced.”

“When looking at EHR vendors, have key considerations (like workflow efficiency, interoperability offerings) and key goals that your practice wants to meet. Using a hosted, cloud-based solution can reduce technical requirements within a practice. Many practices outsource coding, billing and/or collection functions to mitigate staffing needs in this area.” — Corinne Proctor Boudreau, MEDITECH senior marketing solutions manager for physician experience

Across a large healthcare delivery system, technology costs are an investment in better care coordination and health outcomes — they do represent a total savings. Can national requirements or EHR vendors provide the technology needed for smaller practices to have better data access? The “land grab” of healthcare, where large healthcare systems have a competitive advantage in terms of technology, is being driven by a lack of bandwidth to maintain a small practice. Feedback about how regulations affect small practices is needed. The question remains whether consolidation represents the death of the small practice — or whether workarounds can be found to allow these practices to still thrive in an increasingly data-driven system.

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