President Biden’s 2023 State of the Union address outlined the administration’s plan to reduce health care costs for Americans, including lowering health insurance premiums and expanding the $35-a-month cap on insulin costs to anyone who needs it. He boldly declared that cuts to Medicare and Social Security are off the table, and said he would veto any attempt to repeal the Inflation Reduction Act or institute a national ban on abortion.
As a practicing family physician, I am always pleased to hear about ways to reduce the cost of commonly prescribed medications and increase the chances that patients will receive the high-quality care they deserve. High health care costs disproportionately affect lower-income individuals, including many in racial and ethnic groups. The. U.S. is in dire need of more equity in health and health care, and I believe the president’s plan is a step toward ensuring that every American has the opportunity to access high-quality, affordable care regardless of where they live, their race, or socioeconomic status.
As a clinical informaticist, however, I must say that the solutions Biden proposed do not address one of the most significant drivers of administrative waste in the U.S. health care system — health care data.
It’s no secret that the U.S. health care system is plagued by inefficiencies, with administrative costs consuming a staggering 25% of total health care spending, representing $1 trillion per year. A major contributor to these costs is the deficiencies of health data interoperability between electronic health records — meaning one system can’t talk to or exchange data with another — and other health data systems, which results in a fragmented and siloed view of patients’ information. The inability to easily access and exchange data between providers, labs, payers, and public health entities not only leads to increased costs, but also harms patients and clinical outcomes by delaying care, and increasing cost and the risk of medical errors.
The solution won’t be simple. Health data are spread across thousands of hospitals, clinics, novel care sites, labs, and pharmacies, most of which use different IT systems and often store data in different formats, making it difficult to piece together an individual’s information.
I’ve spent much of my career trying to address this problem in collaboration with officials at the Department of Health and Human Services, the Office of the National Coordinator for Health Information Technology (ONC), and many national and regional health IT organizations. We’ve made remarkable progress, but there is still much to be done. As the president said repeatedly in his State of the Union address, “let’s finish the job.”
Today, using ONC-certified health information technology, the vast majority of health systems have the technical capabilities to exchange health information securely and safely with other systems across the country. It’s easier than ever for providers to quickly and securely access extensive data on their patients. Progress has also been made implementing many of the goals of the 21st Century Cures Act, including the Trusted Exchange Framework and Common Agreement, which establishes a universal floor for interoperability nationwide.
On Feb. 13, HHS will recognize the first set of organizations that are approved for onboarding as Qualified Health Information Networks, which will connect to one another and enable their participants to engage in a new era of health information exchange across the country.
However, patient data now flowing in in ever-larger volumes is creating additional obstacles to overcome. In a recent interoperability report, 60% of health system IT executives said the patient data they retrieved through health information exchanges had quality issues, with problematic amounts of duplicative, incomplete, or “junk” data. In addition, 75% of health systems reported concerns around patient privacy and data security as a result of increases in national health information sharing.
Fortunately, there are many for-profit and nonprofit organizations addressing these issues, with new technologies and data-enhancement techniques, innovative frameworks that allow for secure frictionless exchange of information, and consortia to inform federal and state policy.
Every one of the health and social care programs touted by Biden could be made more efficient and effective through more robust, secure, privacy-protecting health data exchange. While the solutions he proposed in the State of the Union address are positive steps toward improving access to health care, the central issue of data fragmentation lurks in the shadows. Without addressing this problem head on, efforts to lower costs and improve access to safe, high-quality care will be limited in their impact. Fixing the country’s data quality and integrity issues must be one of the nation’s top health care priorities to rein in administrative costs, improve secure data access, and, most importantly, allow for an equitable health care system.
Steven Lane is a primary care physician, a clinical informaticist, a clinical professor of family and community medicine at the University of California, San Francisco, and the chief medical officer of Health Gorilla, a California-based health information network and data platform.