The Health Information Technology Special Issue: Continuing the Progress Toward Digital Transformation

Am J Manag Care. 2022;28(1):9-10. https://doi.org/10.37765/ajmc.2022.88810

When The American Journal of Managed Care^® published its first Health Information Technology special issue in 2012, the health care industry was on the precipice of widespread digitization. The subsequent decade brought dramatic increases in electronic health record (EHR) adoption and attestation to the use of defined documentation practices and functionalities that are key to realizing the value of technology-enabled health care. Focused policy-driven efforts, combined with market forces, have resulted in great progress. And yet, despite the many challenges encountered and described by researchers and practitioners along the way, we’ve come to realize that digitization was the easy part. True digital transformation—the reimagining of health care to seamlessly leverage technology in pursuit of safer, more accessible, higher-value care—remains aspirational. Significant work remains for provider organizations to integrate digital advancement as a key strategy in addressing some of the most pressing challenges that are transforming the health care landscape. These include prioritizing performance under value-based contracting, committing to a new understanding of whole-person patient care, and finding an organizationally sustainable approach to virtual patient engagement.

Performance Under Value-Based Contracting

Accountable care organizations (ACOs) and other value-based payment redesigns rely on data infrastructure that supports more effective care coordination and advanced analytics to address unsustainable cost and quality concerns. Apathy et al demonstrate in their work that hospitals do indeed broaden their health information exchange efforts after joining an ACO, but response lags and is a smaller effect in markets where ACO penetration is low. This finding underscores the interdependent nature of organizational investments in data sharing and points to the necessity of continued policy efforts to more directly incentivize, support, and regulate interoperability in the context of value-based payment arrangements. Survey work by Perloff et al describes a different but related ACO challenge emerging from continued data silos. Their work demonstrates, on average, a high number of different EHR developer products in concurrent use within a given ACO and the distinct challenges with integrating, managing, and analyzing these data to generate performance data. These issues, if not addressed, impede the advanced performance tracking necessary for organizational learning and improvement.

Committing to a New Understanding of Whole-Person Patient Care

The information that providers use to make patient care decisions, and that informs more structural investment in population health, is evolving rapidly. Organizations need the capacity to identify and act upon patients’ social needs and risk factors, such as food or housing insecurity, that critically shape their well-being and interactions with the health care system. Given the challenges of collecting these data, Vest et al convened an expert panel to identify and assess the quality of routinely collected structured data that could be used to impute and characterize social risk. The authors highlight data elements that may be most useful in the current data environment, and they also outline plans for the continued development of methods and approaches that mitigate the current limitations and bias with which these data are often recorded. Walker et al also focus on addressing social risk, analyzing a regional effort to promote health system patient referrals to community-based services for food insecurity. Findings illustrate the challenges of implementing the data sharing that is necessary to support cross-sector partnership. The authors offer key insights into how we might address the technical capability and resource limitations, as well as characteristics of the regulatory environment, that impede these critical efforts.