Maintaining health information exchange competitiveness in a new health care market


The COVID-19 pandemic has catalyzed digital transformation in all facets of our society, from politics and economics to training and well being care techniques. Unsurprisingly, the pandemic contributed to the skyrocketing adoption of data applied sciences, particularly within the well being care system. Whereas solely 43% of well being facilities had been able to offering telemedicine previous to the pandemic, this quantity elevated to 95% over 2020. Insurance coverage claims for telemedicine providers additionally grew from roughly 529,000 in February 2020 to 12 million in April 2020.

The digital transformation of the well being care trade shouldn’t be merely restricted to elevated use of telemedicine and telehealth, but additionally the creation of latest care-delivery techniques unexpectedly pushed by brokers exterior to the well being care system, together with new medical expertise startups and retail firms. This additionally could be the very first time that brokers exterior of the market are main modifications contained in the well being care market, with new entrants to the market difficult the function that conventional well being care suppliers have performed. Whereas the growth of accredited telehealth providers and better insurance coverage reimbursements by the Facilities for Medicare & Medicaid Companies (CMS) paved the best way for distant well being care, dramatic modifications in affected person and doctor attitudes, coupled with excessive return expectations of enterprise capitalists and entry of retail firms into the well being care market, have been key drivers of the present digital transformation.

A market that has historically been shielded from exterior competitors is now being disrupted by new, unconventional rivals. In flip, this has remodeled the sphere of well being info trade (HIE), bringing ahead the bigger query of what their function in an evolving and extremely aggressive well being care market.

The function of digital transformation in well being care

CMS and numerous governmental establishments have been main gamers in reworking the well being care system, particularly in response to the worldwide pandemic. Throughout this time, the Facilities expanded accredited telehealth providers to incorporate emergency division visits, house visits, remedy providers, and extra. The Facilities additionally eliminated current restrictions towards letting folks use their houses because the originating web site for telehealth, whereas permitting distant care to be supplied throughout state strains.

These modifications had been coupled with greater insurance coverage reimbursements via Medicare and Medicaid, along with Congressional laws that required medical health insurance issuers to reimburse telehealth providers. Facilitated modifications could be additional propelled by non-market actors reminiscent of expertise and retail firms. As digital modes of well being care supply grew to become extra commonplace, each sufferers and physicians embraced the conveniences and adaptability of telehealth. The pandemic additionally created distinctive alternatives for startups and retail firms to enter the well being care enviornment, and to innovate digital options and resolve current inefficiencies.

Enterprise capital funding for digital well being shot up 66%, from $8.9 billion in 2019 to $14.8 billion in 2020. Throughout the pandemic, retail pharmacies reminiscent of CVS, Walmart, and Walgreens performed key roles in vaccine distribution and testing efforts. The swelling of the normal well being care market has additionally inspired retail firms reminiscent of Walmart, Amazon, and extra to develop into the telehealth enterprise.

Altering market dynamics for HIEs

Altering market dynamics are affecting conventional HIE organizations, that are used to electronically share affected person knowledge throughout docs, hospitals, and specialty care suppliers in a confidential and safe method. Most Individuals’ medical info proceed to be saved on paper, and digital well being information (EHRs) will be troublesome to switch throughout completely different techniques due to technical limitations. The standard worth proposition of HIEs have been their capacity to beat these limitations and supply the excellent medical historical past of sufferers on the time of care. This facilitates supplier communication, enabling a greater use of assets by stopping duplicate testing or re-admissions. HIEs additionally assist enhance affected person care by guaranteeing correct diagnoses and medicine prescriptions.

Nonetheless, as technological standardization turns into extra prevalent, extra events will be capable of bypass HIEs and immediately trade info with one another. For instance, well being clinics run by more and more dominant gamers like Walmart and CVS can acquire and keep their very own well being information on particular person sufferers with out having to combine info into sufferers’ core medical information. Equally, Apple’s new Well being Information on iOS operate permits customers to enter private well being knowledge and talk with docs via EHRs. Epic, a serious firm that holds onto the medical information of 54% of sufferers within the U.S., is one notable firm overlooked by Apple within the roll-out of this new operate. Not solely can these firms select which HIEs to work with, however they disrupt the unique objective of HIEs, which was to centralize medical take care of improved efficacy of affected person care.

The aforementioned modifications within the well being care trade are more likely to drastically alter HIE competitiveness within the new well being care market. If HIEs are in a position to adapt and cooperate with new actors within the healthcare market, this might present distinctive alternatives for elevated interoperability and improved healthcare outcomes. Within the the rest of the weblog, we suggest 4 methods for HIEs to extend their worth proposition and stave off the main challenges that HIEs will face within the digital transformation of well being care.

1. HIEs should diversify community members and knowledge varieties to remain related.

To stay aggressive, HIEs should develop their consumer community and the sorts of knowledge they trade to additionally embrace non-health care knowledge and entities. For instance, they might play an integral half in COVID-19 vaccine verification. Functions reminiscent of CLEAR are shortly positioning themselves because the platform for vaccination verification. Nonetheless, with none connection to a supplier who can confirm a affected person’s vaccination document, CLEAR has no technique to confirm the authenticity of the vaccine card supplied by the affected person. HIEs can circumvent these issues by permitting sufferers to reveal their verified vaccination document and different knowledge to 3rd events. HIEs also can capitalize on the growth of information analytics applied sciences, which have created newer use instances for various kinds of knowledge for each medical and enterprise functions. Areas for growth might embrace collaborations with pharmaceutical firms for trial recruitments, or use of sufferers’ medical knowledge to evaluate dietary wants or meals buying patterns, particularly within the case of persistent illnesses like diabetes. By diversifying their community members, HIEs can assist digital well being instruments, together with prescription treatment reminders or blood stress checks. Whereas these rising capabilities meet the digital wants of the well being care market, they could even be borderline privateness issues, which needs to be thought-about by HIEs needing to enter these new markets.

2. HIEs ought to embrace data discovery of their focus.

HIEs must also develop their providers to transcend synchronous knowledge exchanges and embrace extra asynchronous knowledge curation and data reporting providers. That features going past merely trade knowledge and as an alternative extracting extra invaluable data from such knowledge. The present providers of HIEs at this time will be finest described as on-demand knowledge question providers. HIEs solely pull sure knowledge when an encounter occurs, or a supplier requests the data. On the very least, HIEs ought to concentrate on offering population-level well being reviews for public well being officers. Over the COVID pandemic, unstandardized demographic knowledge has made it troublesome for well being consultants to conduct cross-state comparisons and analyze the influence of COVID-19 throughout completely different demographics. It is a hole HIEs might simply fill. HIEs ought to closely put money into increasing their providers to incorporate high-end knowledge analytics.

Such analytics shall be important in shaping the healthcare market going forwards. Over the pandemic, many restrictions on healthcare modality have been lifted, permitting extra folks to entry telehealth via video convention, audio calls, and asynchronous means. This has opened up new avenues for analysis on the scientific efficacy of varied modalities. HIEs present distinctive assist for suppliers to speak throughout modalities whereas processing invaluable knowledge on how these applied sciences might enhance healthcare.

3. HIEs needs to be working horizontally and vertically to satisfy sufferers and suppliers the place they’re.

Via horizontal integration, corporations make mergers and acquisitions of different corporations which are in the identical place within the worth chain and supply related providers. In distinction, via vertical integration, a agency can develop upward or downward the worth chain and make mergers and acquisitions with different firms which are both suppliers or shoppers of its personal providers.

One of many distinctive strategic benefits of HIEs is their entry to medical knowledge, one thing that’s tougher to acquire in comparison with different sorts of private knowledge. HIEs might construct on this benefit via horizontal integration and elevated interoperability with different HIEs throughout state borders or inside areas. The merger between CORHIO and Arizona’s Well being Present is a step in the best route, combining knowledge for about 1,800 well being care organizations throughout two states and growing alternatives for elevated effectivity and innovation. An much more bold strategy is the Affected person Centered Information House (PCDH) venture led by the Strategic Well being Info Change Collaborative (SHIEC), which seeks to extend interoperability and combine all HIEs throughout the nation.

Present vertical integration by HIEs needs to be expanded to non-traditional well being firms: newcomer tech firms which are proposing new care-delivery fashions, and extra established firms which are reworking particular sectors of the well being care market. Firms which are taking over AI-enabled care-delivery providers, such because the subscription-based primary-care mannequin One Medical, the AI-and-smart-sensor assisted-living service for the aged Zemplee, or the AI-based emergency room triage firm AIdoc, embody new enterprise fashions that may leverage HIE platforms and vice versa. Combining the wealth of medical knowledge from HIEs and the analytics expertise from these new firms can create instrumental synergies. Additional, HIEs can set up relationships with new entrants into the well being care market, reminiscent of Walmart and CVS with their onsite clinics and pharmacies. These firms acquire huge quantities of information from their clients and optimize their providers and merchandise primarily based on such knowledge. In addition they perceive the worth of medical knowledge from HIEs, and will be profitable companions for them.

Future regulation can hinder HIE growth and development in a brand new well being care market

Regardless of the numerous potential for HIEs to develop their providers and keep aggressive within the evolving well being care market, there are some main roadblocks for future expansions, together with issues over affected person privateness and potential regulatory threats. Compounding that is the current last adoption of the information-blocking prohibition rule from the Division of Well being and Human Companies, which can penalize firms for the implementation of sure enterprise practices that may very well be thought-about as hindering info sharing, regardless of the availability of express exceptions.

Well being knowledge is delicate info that, if utilized improperly, might hurt shoppers. In 2011, Fitbit made consumer profiles searchable, exposing the sexual exercise of customers in Google Search outcomes. On-line remedy app Talkspace was met with backlash when, in 2020, former workers alleged that their remedy chat logs had been getting used to enhance machine studying and acquire market insights. Respecting shopper privateness and guaranteeing transparency in speaking what knowledge firms acquire is crucial to establishing belief and goodwill.

HIE development can be impacted by unsure regulation, as within the case of the information-blocking prohibition rule. Whereas clear exemptions have been put in place in order that HIEs can proceed to cost minimal charges for his or her providers, there’s nonetheless a threat that future providers may very well be interpreted as a enterprise observe designed to dam info trade. Additional, the mere bureaucratic burden of a Well being and Human Companies Workplace of Inspector Common inquiry can by itself be very costly for small organizations, and might simply bankrupt a small upstart supplier. The chance of unfavourable publicity can be detrimental to HIE organizations which are accused of data blocking. What provides to those challenges is that the rule is model new beneath a brand new administration, and the COVID pandemic continues to evolve. There may be little or no precedent for policymakers to make clear how the rule could be interpreted and carried out.

These current regulatory measures have put the HIE market on pause and solely time can inform what occurs subsequent. If HIEs are going to evolve with the present digital panorama in well being care, these and different issues have to be addressed.

Amazon, Apple, Google, and Walmart are normal, unrestricted donors to the Brookings Establishment. The findings, interpretations, and conclusions posted on this piece are solely these of the authors and never influenced by any donation.