No second opinion needed: Trust is key to realizing health care IT benefits

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The entire U.S. health care ecosystem is roiled by accelerating waves of change, led by the rising tide of consolidation. This article is part of a special report by Grant Thornton and TechAmerica
Health IT: Trust first, then transformative growth
This consolidation comes in many forms — both actual and virtual — including M&A, shared business models, and information-centric consolidation enabled by advances in clinical and administrative systems, personal health records, mobile devices and health information exchanges.

At the root of this trend is growing trust in the underlying information, IT and business process infrastructures, as well as heightened confidence in the privacy, security, accuracy, reliability, scalability, and performance of these systems and technologies.

While it is imperative systems and business processes deliver on their promised functionality and efficiencies, those benchmarks alone won’t move the needle on improving the quality and price of health care. This outcome can only be achieved when the systems in play interact seamlessly to support all constituencies of the new health care ecosystem: providers, payors, patients, pharmaceutical companies and regulators.

Health care IT providers are uniquely positioned to assist participants in realizing the benefits technology brings to health care, and to help instill a sense of trust in the systems and processes that underpin quality care. Start with these steps:

  • Assist in the risk management process
  • Lobby for reduced regulatory complexity
  • Include patients in the process
  • Engage in rulemaking and reducing the costs of product development and testing
The elements of trust “From a patient point of view, if you see your health improving, that’s a good thing,” observes Steven Reynolds, vice president of market management at Xerox Government Health Services. “Many governments are saying that if patients want the benefits, they have to agree to the use of data to improve care.” Confidence for all parties will increase as familiarity with the systems increases, and the benefits become evident to all involved, Reynolds says.

For individual health care IT providers to succeed, they must first understand customer concerns and develop strategies to overcome them. A good place to start is by conducting a bottom-up assessment of performance around key benchmarks, and identifying areas for improvement:

  • Privacy — Can participants rely on the system to protect their information? Does the system meet expectations for privacy? Is the data secure, and is it being used for its original purpose?
  • Transparency — Can patients and participants see how the information is being used and operates?
  • Reliability — Will the system work, and is it scalable? Is it secure? Most providers can no longer afford to manage their own data centers, but assessing third-party custodians can be a challenge. Does that third party meet the specified standards? Can the provider effectively manage the third party? If the third party uses cloud computing, is it sure that electronic health information is properly protected? Providers are increasingly being measured and paid by performance outcomes, but is the data monitoring accurate?
  • Access — Providers need a system they can access 24/7, in real time. Patients want systems — such as those running remote monitoring devices — to be reliable and accurate, but they also want this extended network to be secure. From the standpoint of a health care IT provider, access often runs counter to privacy concerns.
  • Supply chain provenance — As more treatments occur outside hospitals, health care networks are expanding. Patients are using home monitoring systems and wearable devices. Acute care facilities, labs and other outlets are all plugging in from remote locations — meaning they are part of the network from an economic and delivery standpoint, but they are not direct owners in the system. As the industry consolidates and companies attempt to combine systems, integration issues can quickly compound.
  • Governance — With different regulators and jurisdictions overseeing systems, health care IT providers often face overlapping or contradictory policies that need to be rationalized.

10 building blocks for establishing, and maintaining, trust After the assessment uncovers where the existing system falls short, health care IT providers can begin building an effective technology infrastructure based on the identified needs.

Health care IT providers should capitalize on these opportunities to satisfy the full range of customer and marketplace expectations:

  1. Ensure quality and integration. Providers are not simply integrating with each other; they’re also plugging into systems run by other organizations (e.g., insurers’ networks that track transaction data). If a doctor and specialist use different systems, then neither can rely on those systems to provide complete and accurate data.
  2. Manage risk. Risk occurs at both the individual and systemwide levels. Health care IT must help reduce risk by improving monitoring and data-tracking capabilities, and offering feedback for providers on performance outcomes. While challenging, consolidation will drive increased standardization going forward.
  3. Improve patients’ access to data. Patients are frustrated with the often-complex processes that stand between them and their records — if they can gain access to them at all. Patients trust the information more if they are engaged with it, rather than being excluded from the system. It also benefits providers by ensuring the data is accurate and complete. This enables patients to share data with doctors who may be outside the system, so they can provide a full scope of care.
  4. Secure provider environments. The core of health care IT is built around the integration of health systems and practitioners and their interaction with the public through websites, patient portals, and the availability and accuracy of records. Providers must demonstrate that they have the proper capabilities to deploy health care IT effectively in their communities. They must show their systems are reliable and scalable.
  5. Reduce data breaches. Increased use of mobile technology is complicating the security burden and thresholds that are critical for both health care IT providers and CIOs. As the service landscape becomes more mobile, providers must show their systems are properly encrypted and data is adequately protected. On the upside, mobile access provides a great opportunity for organizations to improve performance outcomes through the sharing of diagnoses and knowledge.
  6. Manage appropriate scale and scope. Integrating the historically fragmented health care ecosystem is an extraordinarily complex task, especially when it is being carried out in the bright spotlight of public scrutiny. As the government has taken a more direct role health care systems, it has learned to exercise caution in the implementation of health care IT. Moving too quickly can increase the risk of failure and undermine trust — take, for example, the troubled rollout of the exchanges. The credibility of the Affordable Care Act (ACA) implementation falls largely on the effectiveness of the health care IT involved.
  7. Adopt and share proper standards. All organizations touched by health care IT must be confident they’re adopting the right standards and that the systems they embrace will function as planned. Organizations need to work together to ensure they’re putting standards in place that will ease integration, while helping them track data in a way that will improve transparency and build patient confidence.
  8. Manage people. Organizations must keep their personnel trained and up-to-date on the latest technological advances. Only through proper training can they understand the infrastructure and evolving technology needs of their organizations. Senior managers and executives, in particular, may have served in the same roles for years and be due for a refresher.
  9. Create actionable information. Connected systems, active monitoring, longitudinal studies, individualized medicine, clinical trials, Medicare and insurance payment systems, electronic health records and personal health records collectively add up to a vast and seemingly disparate trove of information. Advanced data analytics must be applied to help identify actionable trends to both improve patient outcomes and rationalize the cost of health care.
  10. Rationalize oversight and governance. The government’s involvement in exchanges and other provisions of the ACA and Health Insurance Portability and Accountability Act (HIPAA) expands the sphere of trust beyond the commercial side of the business. Now that health care IT is an active player in health care delivery, providers need to shore up their credibility as trusted government business partners. Providers, too, must trust the government as an innovation regulator and evaluator. The government needs to implement health care IT while building confidence through thoughtfully executed pilot programs.
Technology will continue to drive the integration and evolution of health care systems, but for it to be effective, the technology applications must inspire confidence. Health care IT providers need to work with other health care organizations to ensure new technology preserves patients’ rights, while improving their access to data. They must build an infrastructure that is reliable, scalable, secure, and efficient.

As the government’s role continues to grow, technology will be a key tool for combating skepticism from both the public and health care organizations. By focusing on developing trust in health care IT, the industry can lead the health care system into a new age of integration in which technology works seamlessly among all the participants in the health care marketplace.

Contact us Steven Perkins
Managing Partner
Technology Industry Practice
Grant Thornton LLP
T +1 703 637 2830

Liz Hyman
Vice President, Public Advocacy
Washington, D.C.
T +1 202 503 3621

Copyright 2015 Grant Thornton LLP and TechAmerica.