By Mark Tomaino

Before the Affordable Care Act, a medical practice management system (PMS) was used by physicians primarily as an office administration tool to capture patient demographic and billing information, schedule appointments, maintain lists of insurance payors, perform billing tasks and generate reports.

The passing of the ACA, which included the HITECH Act’s stimulus, incenting physicians to adopt and make meaningful use of a certified electronic health record (EHR), led to the integration of an EHR with a PMS. This system integration enabled physicians to address both clinical and administrative needs of medical practices, and allowed physicians to see a patient from both a financial and clinical perspective.

Prior to the integration of a PMS with an EHR, the administration of a medical practice could be compared to the “horse and buggy” era, with manila folders and appointment reminders sent via the U.S. mail. The adoption of EHRs was tantamount to “paving over the cow path” in terms of its basic transformation of paper files to digital information management. The integration of a PMS with an EHR, which enabled clinical information access and exchange in tandem with patient administrative data, was the equivalent of building the healthcare information highway’s “on and off ramps” for sending and receiving digital information and EHR data management.

So where do we go from here? Improving the cost and quality of healthcare for patients will be dependent upon effective care coordination and collaboration between clinicians, their staff and patients armed with the digital information within the EHR and PMS. The transition from fee for service reimbursement of physicians to value-based payments, where quality and outcomes will increasingly take precedence over volumes of procedures and encounters, will demand that clinicians and administers regard their medical practices as patient communication and engagement hubs.

Air traffic controllers and health IT
While ACA provided the catalyst for the digitization of patient encounters and information exchange, outcomes-based healthcare will require medical practitioners to enable their administrative and clinical staff to function more like air traffic controllers than pedestrian crosswalk attendants.

The task of “navigating patients on their journey to satisfactory health outcomes” will require information and communication technologies that resemble the sophisticated systems managing and coordinating preflight, take-off, flight plan, and landing requirements for myriad aircraft representing multiple airlines with different flight plans. The capabilities required by clinicians to care for disparate patient populations representing myriad health conditions dependent upon adherence to multiple care plans delivered across different venues will require a hub-and-spoke network connecting primary care physicians with specialists, and acute care hospitals with post-acute facilities.

Patient “preflight requirements” in a value-based world will require having real-time access to a patient’s longitudinal health record in addition to eligibility and enrollment data. Patient “takeoff” will require transparency about treatment alternatives, and cost and quality differentials. Patient “flight planning” will demand understanding of and compliance with care protocols, and a clinician’s ability to trigger the “fasten seat belt sign” in between physical encounters.

In a value-based world, a physician’s ultimate “landing requirement” for a patient will be a satisfactory outcome. Optimizing profitability of medical practices in a world of performance-based payments will require new and different “navigational systems” to guide patients on their healthcare journey.

In order to truly replicate an air traffic control system for population health management, clinical data must be extracted from disparate patient record systems, and curated into longitudinal patient records that enable providers to identify gaps in care with an ability to trigger a course correction on a real-time basis.

A road paved with evidence-based protocols
While the HITECH Act was a central catalyst for EHR implementation, legislators and regulators will increasingly turn to quality and value initiatives, rather than mandatory adoption of technology. For example, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and Merit-based Incentive Payment System (MIPS) will drive change in the healthcare reimbursement landscape with the objective of delivering more value for the same cost, realize improved outcomes, or same outcome at a lower cost. The mandated assumption of risk (e.g. payment for value) will drive the use of technology as a practical matter.

Quality will ultimately be assessed by measuring adherence or deviation from evidence-based protocols, which will help eliminate unwarranted care – the greatest driver of cost.
Payment transformation will drive innovation in the ways that care is delivered – as more providers assume financial risk, which is inherent in outcome-based payment methodologies, demand for health IT solutions that increase productivity and deliver clinical decision support should increase. Healthcare technology’s promise will be the efficient and effective delivery of care so that providers that assume risk embrace quality-based payment methodologies.

In such an environment, emerging health IT vendors should explore indirect commercialization opportunities such as partnering with larger, well-established firms that have existing customers, but may lack the specific capabilities and solutions that emerging firms possess. Speed to scale will be a success driver, and firms that are willing to collaborate versus a “go it alone” mentality, will willingly trade margin for volume in order to acquire customers in as efficient a manner as possible.

Toward the creation of patient radar systems
The integration of a PMS with an EHR has allowed clinicians to interact with and report clinical and financial information as other than disparate, disconnected data sets. Looking toward the future, these tools must be transformed into a “patient radar system” with new levels of connectivity, tracking, engagement, education and decision support likely beyond the core competency of legacy PMS and EHR vendors. Hence, the medical practice of the future will be reliant upon technologies that emerge from new forms of collaborations between legacy EHR and PMS vendors, and best of breed solution providers that deploy cloud-based solutions that can easily integrate and seamlessly exchange information with existing systems.

In a value-based healthcare market, technology that sustains a network of interconnected clinicians that track and manage a patient’s health status, automate the development and distribution of care plans and monitor patient compliance with treatment protocols will be as commonplace as air traffic control systems. Clinicians and administrators will demand these capabilities in order to “clear patients for satisfactory outcomes” as they pursue their healthcare journey.

About the author: Mr. Tomaino is an Operating Partner and focuses on investments in the healthcare information technology industry, having joined WCAS in 2010. Mr. Tomaino was previously Senior Vice President, Corporate Development at The TriZetto Group. Prior to joining The TriZetto Group, Mr. Tomaino worked at Bausch & Lomb Incorporated in a variety of legal, strategy, and business development roles.