Healthcare would benefit from a patient-centered digital ecosystem, says Blue Shield CEO

Photo: Al David Sacks/Getty Images

Right now, the digital health ecosystem in healthcare is a complex tangle of often incompatible technology and sets of data. 

The industry promises interoperability and payers are being mandated starting next month to meet Fast Healthcare Interoperability Resources standards for patients to access their clinical data, but as it stands, consumers aren't being reached in meaningful ways and their access to their own health data is spotty, at best.

Paul Markovich, president and CEO, Blue Shield of California, used the analogy of photographs to describe the patchwork state of technology solutions in healthcare. When people take photos with their phones, he said, they can upload them to Facebook or Instagram, or email them to friends or relatives, all from the same device, with ease and simplicity.

In a perfect world, data in healthcare would work much the same way. Instead, it's as though people are taking photos that belong to, and reside with, third-party entities that send those photos back to the consumer in disparate formats, and with the need to install different apps to communicate with each entity. Replace photos with data and health information, and that's the current state of interoperability in healthcare with all of the different rules that are in place.

Speaking at the AHIP annual conference in a keynote session entitled "Advancing a Digital Health Ecosystem: The Time is Now," Markovich said the ultimate goal for healthcare should be a comprehensive digital record on an open platform -- meaning people can do with their health data what they do with their photographs. While the concept of interoperability tends to revolve around electronic health records, standardizing the entire digital infrastructure in healthcare may prove even more effective.

"I'm thinking about it in layers,"said Markovich. "It can't get to its maximum effectiveness unless you have basic information. My fundamental concern right now is we can't get to those things at scale until we first fix this underlying problem."

There are a couple of barriers to achieving a comprehensive digital ecosystem in healthcare, he said. One is the tremendous inertia in the industry: There's a good deal of complacency and acceptance of the status quo.

Another issue, though, is that consumers don't actively use digital cost and quality tools, with the larger industry seemingly unable to bring tools to consumers that they actively want to use and engage with.

"I think of things like cost comparison tools," Markovich said. "They're based on the premise that people want to shop for these services, and there are very few people who do. Then we try to create benefits to force people to do something they don't really want to do, which is shop for these healthcare services. How does the consumer want the world to work? A lot of these tools get constructed from the vantage point of the healthcare system as opposed to the vantage point of the consumer."

There are a number of ways to address the issue. First, Markovich said there needs to be a mandate from lawmakers; the industry itself likely won't change the system on its own.

Secondly, there should be a centralized repository for data, a health information exchange of some sort. Barring that, there needs to be a mandate that health plans pull together all aspects of patient digital records and provide them to their members as well as the treating physicians, all within a certain timeframe and all in an acceptable, standardized format.

Achieving this is no longer a technical issue. It's largely a matter of pulling out the relevant data, tossing it up into the cloud and matching it to the right patient. The problem is that electronic health records are like Microsoft operating systems in the 1990s: They're a local installation. They're not ubiquitous or workable for the consumer. 

Markovich favors having a series of health information exchanges, akin to the series of interconnected hubs that comprise the internet. There are fundamental things that need to be done to pull the records together, such as patient identification, fixing formats, curating data and sending it only to the people who need to see it, and shoring up cybersecurity. 

"I'm a big fan of just a mandate and potentially public funding with public oversight, but a public-private partnership," said Markovich. "Don't ask the federal government to build this thing, but if you make the private industry do it to certain specifications and provide funding to make it happen, that creativity gets unleashed."

Artificial intelligence, and machine learning especially, have the ability to make a difference, though it may take a while for it to move the needle. Blue Shield of California has been using that tech to project claims and claim costs, but Markovich believes there are potentially much bigger applications.

AI done well can drive value, but the system should revolve around patients, rather than ask patients to navigate a complex and sometimes dysfunctional system. If the flow of money is going to providers who are in a digital world, under value-based payments and digital tools, the industry will move there faster because it will be the only way for them to maintain their financial flow, said Markovich.

"Increasingly, more progressive health plans and physicians and providers are going to be moving into value-based payments, and when they start getting better results they're going to start winning the day, and that will push the industry in general in lining some of these things up," he said. "We're potentially a decade in the making of all of this. It's got to come from the industry and it has to be prompted by payers."
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com