As I spent time in Washington, D.C., several weeks ago, it was clear that much of the focus in the healthcare IT industry has settled on the secondary use of health data. Talk of health information exchanges (HIEs) was, of course, still the rage, but conversations centered on topics like how to secure data for access by physicians not on the patient’s care team (an authorization discussion), leveraging the NHIN’s CONNECT software (an open-source implementation initially designed to connect the twelve federal agencies), data standardization (to enable reporting and analytics), interoperability standards to achieve meaningful use, and statewide backbones to facilitate exchange at a broad level.
This is all great, of course, but lost in most of the conversations was the recognition of the simple need to exchange information to solve the primary use of data – namely, to facilitate business transactions like orders, results, referrals, consults, and other elements of day-to-day workflow.
Why is this so important? Because the “elephant in the room” lurking behind all of these HIE and EHR discussions is the requirement to change the culture of providers to embrace the use of new computerized systems. And we all know that people don’t change easily – normally they do so to avoid pain. So, the question becomes: Is the secondary use of data enough to reduce existing pain points among providers? Unfortunately, the answer may turn out to be “No.”
If, however, we approach the issue from the standpoint of the psychology of users, then we will seek to reduce an existing pain, to encourage system adoption, and to add more functionality over time. This is where primary data uses come into play. We know from experience that physician practices spend an inordinate amount of time collecting information from local hospitals, labs, and others, as well as placing orders and referring patients. The time spent on these tasks represents a significant level of pain to practice staff. If we can address this pain, these critical users will be encouraged to use the system.
Now the interesting part: if the HIE addressed the primary data uses first, it would “liquefy” the data needed for secondary use as a natural byproduct of the exchange. In other words, building an HIE to support primary data exchange would be able to address the secondary uses and better guarantee success – simply by leveraging basic human psychology.
