The Tipping Point for Digital Chart Adoption


John D’Amore, President and Co-founder

It’s no secret that healthcare has extended the lifespan of antiquated technologies, like the fax machine, far longer than appropriate. This sometimes just causes a hassle for patients and clinicians but other times jeopardized decisions that affect millions, such as during the COVID-19 pandemic. Population health and value-based care programs still rely heavily on manual chart chases while patients continue to gather medical records from one doctor via thumb drives, snail mail and email. Over 200 million chart chases are estimated to be performed annually and over 80% are conducted via mail or fax.

The last few years have seen some reduction in these laborious practices, but the pace has been slow. Too slow. But that’s all poised for change.

Today we are at a tipping point in the use of digital health data – or what we can think of as the “digital chart” – health data interchanged electronically and in a computable fashion rather than a paper equivalent. Why now? Here’s what lit a fire under healthcare’s typical glacial pace of change.

  • The Pandemic: Onsite chart chasing? No thanks! Administrative activity associated with manual chart retrieval was either suspended entirely or grossly slower during COVID-19 shutdowns.
  • Regulation: Government mandates for increased data exchange which go into effect in 2021. We’ve written a four-part series on this if you want to read more on the regs.
  • Data Availability: Clinical document exchange through networks has finally reached widespread adoption. It’s now the exception rather than the norm that a clinician only has the option to fax information.

The Road to Adoption

The HITECH Act and Meaningful Use program spurred today’s widespread use of electronic health records (>90%). It also established requirements for how clinical data is to be captured and shared among EHRs. In 2010, there were few exchanges of clinical data, but through the mandated adoption of EHRs, the volume grew to hundreds of millions clinical document exchanges by 2018. It is estimated that as of today, there are 2.5 to 5 billion exchanges occurring annually across the healthcare ecosystem. The primary form of these exchanges are C-CDA documents, which is a standard mandated by all certified EHRs (I contributed to its authorship).

(See sources below)

As a result of the growth in clinical document exchange over the past decade, the availability and amount of clinical data is now abundant. The primary challenge the industry faces today with clinical data is that it is captured using different systems and nomenclature which renders it hard to use. Without normalization and enrichment, clinical data are often unusable for providers or health plans. But that’s a data integration challenge that automated systems (like Diameter Health’s) can overcome.

The COVID-19 pandemic, paired with the increase in clinical data exchanges and federally mandated exchange of health data, will continue to shift the healthcare industry towards adoption of the digital chart.

Remaining Obstacles to Overcome

To keep the opportunity before us on the fast track, there are still obstacles we must overcome as an industry. These include:

  • Removal of the technical and regulatory rules that promote the use of paper or paper equivalents over digital health data (for example, NCQA and HHS should recognize the C-CDA as a legal health record when appropriately authenticated and signed)
  • Improved workflow for data collected during patient encounters that don’t place extra burden on providers (CMS created a new Office of Burden Reduction in June of this year in recognition of this need)
  • Use automation to transform data into normalized, enriched data that can be easily summarized and leveraged for transactions (e.g. prior authorizations), quality measurement (e.g. HEDIS) and other analytics (e.g. population health or risk adjustment)

I am excited about the opportunities that lie ahead for the healthcare industry. We are at the tipping point for digital health record adoption. This will improve the quality and cost of care and this trend will accelerate as it becomes clear that we’ve relied upon costly manual and administrative processes for far too long.

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