"Too many people own part of the [interoperability] value chain, which is a huge problem with the business case," Trish Birch says. "When you look at the process for chronic care management—and this is where the ROI problem comes in—there are too many people who own part of the process. ROI presupposes automation. Everyone [also] has to play nice and you have to give them some economic incentives to address the problem.” Excerpts:

“Birch cites the work Cognizant did on a solution to automate orders for home monitoring devices upon a patient's discharge from the hospital. It sounds simple enough. The physician writes the order in the EMR, which sends it to the company that handles the facility's supply chain, which ships the device to the patient's home where it is installed and can begin transmitting information back to the EMR. There, data are automatically analyzed and alerts are triggered when the system's algorithm identifies a potential issue.

‘It sounds straightforward, but it's not,’ Birch says. ‘The hospital, physicians, and EMR [vendor] need to cooperate to get the integration and change management done. Then you have the suppliers, who have to have the capabilities to very cost-effectively manage and ship the devices, and provide the clinical call center and analytics piece. All parties need their role in automating this process to be economically worthwhile, but still keep [costs to the patient] below a set price. And that's all for just one narrow postdischarge monitoring process. This is where scale and the right digital tools will matter.

‘There are a lot of unproductive components in health care processes. They need to be squeezed out [and] simple tools [provided]’ if value-based payment programs are going to truly succeed, she adds. ‘At the core, there has to be a lot of simplification of process and rearchitecting of the value chain.’”

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