This past weekend provided several stories that emphasized the continued need, almost a crisis, for improving transparency and sorting through complexity on health information to lower cost and improve care.
Starting at the end of the weekend and working backwards, every football fan in the country has seen or heard about the botched call in the Seahawks/Packers game, and the continued concern the replacement referees are not up to the game’s level of difficulty and speed. Not only is the speed of the plays challenging to monitor, the rules are different and more complicated than their experience may support. Understanding the information as it is presented, in real-time, is an overwhelming effort.
Additionally, the New York Times cast a light on a debate on the evolution of electronic healthcare and EHRs by reporting an analysis by HHS that the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare and insurance plans. HHS responded with a letter reminding the healthcare provider community (represented by the associations addressed) that using EHRs to support fraudulent billing was not allowed. The American Hospital Association responded, and pointed out the complexity of billing codes, and its desire to work with CMS to improve transparency and aid analysis.
On top of this, the release of the Joint Commission’s list of “Top Performers” in healthcare generated debate about “winning the game,” as hospitals top-ranked in other, similar surveys were left off completely, prompting Dr. Peter Pronovost, director for the Center for Innovation in Quality Patient Care at John Hopkins, to state “what we need is a Securities and Exchange Commission[SEC] for healthcare.”
Dr. Pronovost points out the SEC oversees public rule setting for financial activities and transactions, and has driven changes to transparency in financial reporting, underpinned by private sector auditing and exhaustive analysis. In healthcare, however, he notes, ”the public is left saying, ‘what do I do? Here’s a report saying a hospital is great and another saying it’s not so great.’”
“Blown calls,” “gaming the system,” “lack of transparency” – All fertile ground for continued improvements in standards-based interoperability!
Since 2009, the SEC has led a regulatory effort to improve transparency in financial reporting, driven by the use of “interactive data” and the eXtensible Business Reporting Language (XBRL). Much like HL7 and other health data standards, XBRL facilitates the seamless exchange of financial information to and from different systems.
In fact, XBRL is based on the same “rules” as HL7 CDA, making it possible to integrate the clinical data with non-clinical, financial and performance data to improve transparency and improve analysis.
XBRL is quickly approaching uptake in the federal government with the consideration of the DATA Act by Congress. It seems undeniable, as the federal health community must consider transparency in its data, these requirements may be “baked into” the growth in accountable care and efforts to achieve “triple aim” in care management.