HHS Strategy to Address Information Exchange Challenges Lacks Specific Prioritized Actions and Milestones
Innovation
Could subtle psychological cues lead to better medical decision-making?
Mike Miliard, Managing Editor
COLUMBIA, MO | February 17, 2014
Article link: http://www.healthcareitnews.com/news/ehr-redesign-could-reduce-unneeded-tests
When it comes to America’s healthcare costs, spiraling ever upward, one of the main culprits is unnecessary testing.
Victoria Shaffer
Some 130 oft-overused screenings and treatments should be curtailed, according to the two-dozen organizations affiliated with the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign.
Indeed, as Scientfic American pointed out in its article about that initiative, the Instiute of Medicine estimates that $750 billion – three-quarters of a trillion dollars! – was spent on unnecessary services and excessive administrative costs in 2009.
“We are, I hope, at a turning point in American health care where we’re realizing you want to have the right health care, not just more health care,” Baylor College of Medicine pediatrics professor Virginia Moyer told the magazine.
Well, not quite yet. Many thousands of docs are all too happy to order excessive lab work and imaging – and defensive medicine may be a big reason why. As Doug Campos-Outcalt, a Phoenix, Ariz.-based family physician, told Kaiser Health News, “Nobody ever gets sued for ordering unnecessary tests.”
Or what if that wasn’t the reason? What if reducing these excesses is a bit easier to explain, if a bit more deeply rooted?
Victoria Shaffer, assistant professor of health sciences in the University of Missouri School of Health Professions, has been working on research related to the psychological roots of how physicians make decisions.
With a degree in quantitative psychology, Shaffer says she’s long been interested in studying human judgement in decision-making.
Specifically, she’s keen on what makes clinical decisions tick – those made by both doctors and patients in the exam room. Her research is “essentially taking a broad range of academic research in psychology and applying it to specific judgements from the physician and patient perspective,” she says.
One of Shaffer’s recent projects has shed some interesting light on what drives physicians to order tests – and suggests that the reasons may be more subconscious than we may have thought.
In a study first published in Health Psychology, Shaffer, working with Adam Probst, a human factors engineer at Dallas-based Baylor Scott & White Health, and Raymond Chan, MD, a pediatrician at Children’s Mercy Hospitals and Clinics in Kansas City, Mo., took a look at how the lab tests from which a doctor could choose are presented in electronic medical systems.
Shaffer and her team studied how docs picked lab tests using three different designs of order set lists. The first was an opt-in version with no tests pre-selected, as is found on most electronic health records. The second was an opt-out version, in which physicians had to de-select lab tests that weren’t clinically relevant. The third had just a few tests pre-selected, based on experts’ recommendations.
By Former Sens. Tom Daschle (D-S.D.), Trent Lott (R-Miss.) and John Breaux (D-La.) – 02/12/14 06:07 PM EST
As Washington continues to debate ObamaCare, technological innovations have advanced to new levels, presenting a bipartisan opportunity to give Americans access to new ways to connect with their doctors.
Whether it involves patient portals, mobile apps, electronic health records or remote patient monitoring, technology has the power to bring high-quality care to more people with increased transparency and patient engagement. Telehealth, or as we like to call it, connected care, is harnessing technology through greater broadband deployment and adoption of new modalities to address gaps in the current system.
Patients who need primary care, chronic disease management, mental health consultations or even specialty care such as dermatology, can communicate with their physicians remotely through a laptop, iPad, smartphone or kiosk. Patient care is available after-hours and on weekends, often in a patient’s home or in another convenient location. This is not merely a big step for patient convenience; it also represents an opportunity to improve the quality of care and promote care coordination.
The Department of Veterans Affairs has been a pioneer in connected care. In fiscal 2012, nearly half a million veterans received 1.429 million remote care contacts. In the Defense Department spending bill recently signed by President Obama, one of the few amendments added to the bill extended healthcare services to transitioning veterans through telemedicine.
It is time to make connected care a bipartisan priority in Washington. Imagine an elderly woman with diabetes who can consult a doctor about managing her disease without having to leave her home, or a working parent who can video chat with his child’s pediatrician, or a patient in need of mental health services but too afraid to go to an office able to access care through a laptop, or a doctor who can monitor a patient already discharged from the hospital.
To achieve the true promise of connected care, we must ensure that our legal and regulatory structures allow Americans access to these innovations. We currently have rules that never anticipated what is possible today. We have an opportunity to embrace new platforms for the delivery of healthcare and prevention of chronic disease and to do so in a way that protects patients’ sensitive information.
Given the benefits of this technology, policymakers across government should be, and we believe are, asking themselves what they can do to expand its use while ensuring that appropriate safeguards are in place.
For example, we have created a major emphasis on keeping people out of the hospital with prevention, chronic disease management, care coordination and readmission penalties. But, we still don’t reimburse home health agencies for remote patient monitoring, nor do we pay for patients to check in with care providers from their homes via real-time video.
We must create a consistent definition of connected care that will promote participation and broaden acceptance of remote care among providers, payers and patients. We must also address the lack of broad and consistent reimbursement, insufficient broadband infrastructure, inconsistent state medical licensing and varying degrees of clinical permissibility.
The time is right to address these issues, and the following facts are indisputable: • Technology is more widely recognized as a job creator and an engine for economic growth. • The evidence base for connected care has grown. Studies are published regularly that demonstrate improvements in quality, access and cost – including one recently that highlighted how Partners Healthcare System in Boston reduced readmissions of 1,200 heart failure patients by 50 percent through a home health telemonitoring program. • Connected care aligns with broader efforts to strengthen the nation’s healthcare system. Notably, an emphasis on accountable care is putting pressure on providers to be in better contact outside of the office or hospital setting, and connected care offers a low-cost way for providers to follow up with their patients. • States and commercial insurers are increasingly reimbursing for connected care. In 2013 alone, legislation was introduced in 25 states to advance some type of telehealth policy, and 20 states now require commercial insurers to cover telehealth services. • As the expansion of coverage continues, more people will be enrolled in private health insurance plans or Medicaid than ever before but might not be able to access a physician. Connected care can help consumers find a doctor that suits their health needs.
Technology can be a powerful tool in meeting our healthcare challenges. To maximize its potential, we must pave the way by ensuring our laws and regulations keep pace with innovations in connected care.
Daschle, Lott and Breaux are co-chairmen of the Connected Care Alliance, a diverse coalition of companies dedicated to patient access to care through advanced technology.
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Read more: http://thehill.com/opinion/op-ed/198269-connected-healthcare-is-our-future-if-washington-acts#.Uv4lQZIpyfs.twitter#ixzz2tPKgVSNo Follow us: @thehill on Twitter | TheHill on Facebook
Article link: http://annals.org/data/Journals/AIM/927426/0000605-201308200-00011.pdf
The Affordable Care Act made preliminary efforts to collect and disseminate data on health care price, utilization, and quality in the United States. This commentary proposes that all such data need to be publicly available to achieve a health care system that delivers high value.
Steven Brill’s “Bitter Pill” Time cover story (1) shed disturbing light on the lack of price and quality transparency in U.S. health care. He reveals that many stakeholders in the health care system profit from concealed price and quality information, including poor-performing and high-priced insurers, providers, and suppliers (1). All of us are harmed through higher premiums and less-effective competition. Most important, patients may inadvertently place themselves at higher risk for injury or unwittingly pay more for poor-quality services.
The Patient Protection and Affordable Care Act (ACA) made significant albeit preliminary efforts to collect and disseminate price and quality data. More action is essential, by shifting the basis of competition from structural market power to delivery of better value. To achieve this, we propose the transparency imperative: All data on price, utilization, and quality of health care should be made available to the public unless there is a compelling reason not to do so. The transparency imperative is part of the foundation for a post-ACA health care system that achieves better quality and cost control.
Prices
Few patients have any knowledge of prices for any health care service, from a laboratory test to surgery. More important, obtaining such information is almost impossible. First, services comprise different inputs, so it’s hard to obtain a unified price. Second, commercial prices are almost completely opaque. For example, differences in pricing power among hospitals has led to large disparities in price (typically more than 200%) within local markets, with little relationship to differences in quality (2). This remains true even within most preferred provider organization insurance networks.
Utilization
It’s very difficult for patients to discover how many procedures a physician or hospital performs, yet utilization is critical for informed decision making. Physician case volume is one of the most important predictors of quality for many surgeries and medical conditions. For instance, it is estimated that a urologist needs to perform more than 700 robotic prostatectomies before the learning curve flattens out (3–4), yet determining how many procedures a urologist has performed is virtually impossible. Famously in 1979, the American Medical Association sued Medicare to block the release of data on the number of procedures billed to Medicare, claiming physician privacy (5).
Quality
Access to quality data is limited, and better performance has not led to gains in market share thus far. Few good-quality metrics exist, and the ones that do are largely limited to inpatient care processes for coronary artery bypass graft surgery, congestive heart failure, chronic obstructive pulmonary disease, diabetes, community-acquired pneumonia, pregnancy, hip replacement, knee replacement, and organ transplantation. Quality data that are publicly disclosed, such as Medicare’s Hospital Compare, are of limited utility because they are reported vaguely in most cases as “No Different than U.S. National Rate” or “Better (or Worse) than U.S. National Rate.”
The ACA contains requirements to release Medicare claims and Physician Quality Reporting System (PQRS) data. However, very few of these data have flowed into the public domain, probably the biggest limitation being risk aversion. Unfortunately, the data have been released to only a few “qualified entities” (6). The intent was to be sure that such entities had the technical capacity to analyze the Medicare data responsibly. But the latest regulations significantly restrict the flow of data and preclude smart but inexperienced people on tight budgets from analyzing them (6).
Initially, one would think that health plans should have the greatest desire to make price and quality transparent to their members because they capture savings when members choose better-value providers. Unfortunately, transparency is not necessarily their top priority. To satisfy the desires of employees, many employers demand broad provider networks that include market-dominant providers, such as prominent academic centers that prohibit transparency in 30% to 40% of cases. They try to keep costs down by negotiating rates instead of providing information and guiding patients to better-value providers.
Price and quality information are imperative for new payment models. With expansion of risk-based reimbursement models like accountable care organizations and patient-centered medical homes, providers will have to identify high-value providers who can consistently deliver high-quality care with fewer complications at an affordable price to capture more savings, achieve quality metric goals, and earn higher incomes.
For meaningful progress on transparency to occur, there must be a change in attitude throughout the system. All payers should be required to make their claims data publically available, with privacy protections, to enable quality measurement. Of importance, to protect privacy, the federal government should substantially increase the penalties for inappropriate patient re-identification.
Personalized pricing information should be made available for comparison before patients enter a care process. Both total price and patient price should be transparent to providers in shared-savings payment models to enable cost management. Only patient price should be available to providers in fee-for-service networks to mitigate the risk for price increases.
Fortunately, there is much that stakeholders can do. The federal government can relax restrictions on access to Medicare data. Other states should follow the lead of California and Massachusetts and require providers to disclose prices to patients before elective care. Health plans and employers should also support such transparency tools as Castlight (www.castlighthealth.com).
If we are going to bend the cost curve, a better functioning health care market is critical. Transparency is essential for patients to consume care from providers who deliver greater value. For providers, transparency is essential for risk-based reimbursement models to work. It is also the best approach to overcome local monopoly pricing power by providers. Most important, the current health care marketplace is ripe for patients to capture large and unjustified differences in price and quality. As more patients do this, we all benefit from more effective competition and health care prices that better reflect value.
Brill S. Bitter pill: why medical bills are killing us. Time. 4 March 2013.
Robinson JC, MacPherson K. Payers test reference pricing and centers of excellence to steer patients to low-price and high-quality providers. Health Aff (Millwood). 2012; 31:2028-36.
PubMed
Freire MP, Choi WW, Lei Y, Carvas F, Hu JC. Overcoming the learning curve for robotic-assisted laparoscopic radical prostatectomy. Urol Clin North Am. 2010; 37:37-47.
PubMed
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Alemozaffar M, Duclos A, Hevelone ND, Lipsitz SR, Borza T, Yu HY, et al. Technical refinement and learning curve for attenuating neurapraxia during robotic-assisted radical prostatectomy to improve sexual function. Eur Urol. 2012; 61:1222-8.
PubMed
CrossRef
Florida Medical Association, Inc. v. U.S. Department of Health Education and Welfare, 601 F.2d 199, (M.D. Fla. 1979).
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Article link: http://gizmodo.com/a-tiny-new-chip-promises-internet-400-times-faster-than-1521523614
Fast internet is fast. Google Fiber’s gigabit connections? That’s like driving a sports car compared to the go-cart-speed connection that’s probably in your house. But new technology from IBM opens the door for connections that are beyond fast. Comparatively, it’s like flying a fighter jet.
IBM researchers in Switzerland just unveiled the prototype for an energy efficient analog-to-digital converter (ADC) that enables connections as fast as 400 gigabits per second. That’s 400 times faster than Google Fiber and about 5,000 times faster than the average U.S. connection. That’s fast enough to download a two-hour-long, 4K ultra high definition movie in mere seconds. In short, that’s incomprehensibly fast.
The ADC chip itself was actually built for loftier purposes than downloading episodes of Planet Earth, though. It’s actually bound for the Square Kilometer Array in Australia and South Africa to help us peer hundreds of millions of light years into space, hopefully to give us a better idea of what the universe was like around the time of the Big Bang. This massive radio telescope will devour data, too. It’s expected to gather over an exabyte every day when it’s finished in 2024. That’s over 100 billion gigabytes.
Believe it or not, 400 gigabit isn’t even the fastest connection the world has seen. For that you’ll have to go to the United Kingdom where researchers recently developed 1.4 terabit internet using commercial-grade hardware. That’s warp speed. [ZDNet]
Statewide Website Will Soon Allow New Yorkers Access to their Healthcare Records Online
NEW YORK, Aug. 14, 2013 /PRNewswire/ — The New York eHealth Collaborative (NYeC) announced today that Mana Health, a New York City-based Health IT start-up, was awarded the vendor contract to build the Patient Portal for New Yorkers. The portal is a website through which New Yorkers will be able to access their healthcare records safely and securely online.
(Logo: http://photos.prnewswire.com/prnh/20120816/NE58665LOGO )
The Patient Portal for New Yorkers website will become available to patients beginning in early 2014 in select parts of the state. Additional capabilities are also in development and will be rolled out over time.
Via the portal, patients whose providers are participating in the program will soon have online access to their personal healthcare data, including lab results, lists of medications, radiology reports, and other information about procedures and medical conditions from the various providers they see. Patients will also be able to decide who can access their data such as their doctors or family members.
Mana Health was awarded the contract to build the portal by an interdisciplinary team of representatives including the New York State Department of Health, NYeC specialists, and Regional Health Information Organizations (RHIOs), who reviewed all bid submissions. Mana Health’s bid was deemed to have the best understanding of the needs of New Yorkers. Mana Health was also the winner of the Patient Portal for New Yorkers Design Challenge, held earlier this year. The Design Challenge was launched to source the most innovative and user-friendly portal designs and was voted on by the public at large.
Mana Health will work directly with NYeC to build the user interface for the portal website and its connection to the Statewide Health Information Network of New York (SHIN-NY). The SHIN-NY is a secure network for sharing clinical patient data across New York State.
“New Yorkers do everything else online. It’s imperative that they also be able to access their healthcare data online, whenever they need it. This is the most important information a person has about him or herself,” said David Whitlinger, Executive Director of NYeC. “We are excited to be partnering with Mana Health to provide patients across the state with that access.”
“Our aim is to empower today’s patient-consumer with an insightful and easy-to-use tool to familiarize themselves with their health data,” said Chris Bradley, CEO and Co-Founder of Mana Health. “Working with the great minds at NYeC to support this statewide patient portal for New Yorkers is truly a dream come true.”
For more information about the Patient Portal for New Yorkers, please visit www.patientportalfornewyorkers.org. For more information about Mana Health, please visit www.manahealth.com.
About Mana Health: Mana Health is a healthcare technology company that uses data to make healthcare work better. Based in New York City, their team is comprised of experts from across healthcare, software development, consumer experience, and analytics. Mana Health’s first product, the Mana Patient Gateway, offers an engaging experience that empowers patients through their HIE, hospital, and employer data. Learn more at www.manahealth.com.
About The New York eHealth Collaborative (NYeC): NYeC is a not-for-profit organization, working in partnership with the New York State Department of Health to improve healthcare for all New Yorkers through health information technology (health IT). Founded in 2006 by healthcare leaders, NYeC receives funding from state and federal grants to serve as the focal point for health IT in the State of New York. NYeC works to develop policies and standards, to assist healthcare providers in making the shift to electronic health records, and to coordinate the creation of the Statewide Health Information Network of New York (SHIN-NY), a network to connect healthcare providers statewide. For more information about NYeC, visit www.nyehealth.org and @NYeHealth.
SOURCE New York eHealth Collaborative
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Additional Implementation Details Would Increase Transparency of DOD’s Plans and Enhance Accountability
“The journey, and work, is far from over,” said Paul Tang, MD. “But with the progress the country has achieved, the train is well out of the station, and we are well on our way towards a more adaptable and rational health system.”
Strides have been made on digital front, yet big problems remain to be solved
January 17, 2014
The healthcare IT industry just marked the 10-year anniversary of then President George W. Bush’s call to action – in his 2004 State of the Union address – to finally transform a paper-mired healthcare system into a digital-age industry that operates more like other sectors of the economy.
As we look back on 10 years, we spoke to some leaders on the frontline of health information technology, asking them to take measure of how far the industry has moved towards a truly high-tech, data-driven system of care.
Bill Spooner, Sharp Healthcare
Bill Spooner, vice president and chief information officer of Sharp Healthcare in San Diego has had an epiphany or two on his way to digital transformation. There was a time, for instance, when he advocated for best-of-breed systems. But he changed his tune when he realized there were too many interoperability headaches.
In an interview with Healthcare IT News in early 2010, Spooner addressed the issue of best-of breed technology versus enterprise systems.
He was proud, he said, of his and his colleagues’ willingness to make a change when it became clear they needed to go in a different direction on their core hospital systems, or EMR, back in 2006.
Bill Spooner“We were willing to recognize that the strategy we were taking in terms of our best-of-breed group of products just wasn’t going to bring us the value that we really needed to achieve,” Spooner said in the interview. “We began to pull out a half a dozen best-of-breed products in exchange for the integrated group of products that we are now implementing from Cerner.”
Spooner may have been early to change his tack, but today he is far from alone, with many medium and large health systems rolling out Epic or Cerner EHRs. Even pioneers in health IT are replacing their homegrown systems with commercial systems, usually with either Epic or Cerner, the two most selected enterprise EHR companies in the market today.
Partners HealthCare in Boston is in the midst of an Epic system rollout. Intermountain Healthcare in Salt Lake City recently announced a partnership with Cerner.
“We have very set ideas on how we think these systems should work, and we feel very passionately about it,” said Intermountain CIO Marc Probst, in a video announcement last September. “Intermountain is committed to being innovative in the area of information systems.”
Intermountain is recognized as one of the pioneers of innovation, having built its own systems from the get go to advance its data-driven approach to healthcare, which continues today.
Cerner’s open architecture technology was critical to Intermountain’s decision to partner with the EHR vendor, Probst said. Among other advantages, the open architecture will allow for the addition of the new Intermountain content. Cerner’s focus on population health was another attraction.
“We share a common vision to improve care for populations of people,” said Brent James, MD, chief quality officer at Intermountain.
“This partnership will accelerate our efforts to provide core functionality to our caregivers as we create new innovations to transform healthcare,” he added, in a video announcing the launch. “By integrating the Cerner system with our electronic data warehouse, we will continue to drive improvements in healthcare quality.”
At Partners HealthCare, Scott MacLean, deputy CIO and director of IS Operations, said: “We realized that much of the functionality we developed is available commercially, so we’re adopting a vendor platform and will focus our innovation on genomics and other research discoveries we want to bring to the bedside and clinics.”
Sharp Healthcare’s Spooner said that today the health network has very little paper comprising the patient record. Physicians enter orders virtually, and they document online.
“The data has become actionable for care improvement,” he said.
In the not so distant past, physicians at Sharp Healthcare were not convinced the EMR was essential to the quality patient care, Spooner said. “Today they see it as indispensable to care. My challenge is to regularly bring added or improved EMR functionality, and to ensure constant availability – no scheduled or unscheduled downtime.”
Paul Tang, MD, Palo Alto Medical Foundation
As vice president and chief innovation and technology officer at the Palo Alto Medical Foundation, as well as a top federal policy adviser, Paul Tang, MD, brings a unique perspective, as does Probst who, like Tang, serves as CIO at Intermountain and also sits on the federal Health IT Policy Committee, which advises the federal government on healthcare IT matters.
The HITECH legislation, and the EHR Incentive Program in particular, was the most significant and impactful HIT federal policy in the past decade, Tang said. It was also a necessary enabler for the Affordable Care Act that followed a year later, he added, since health information technology and EHRs are essential to support the transformation required by health reform.
“It’s clear that providers – both physicians and hospitals – cannot undertake the transition from volume to value without knowing their current performance and its costs and without having an electronic infrastructure to effect continuous improvement,” Tang said.
Tang is optimistic. He noted that in just two years time, the number of providers who have achieved meaningful use soared from about 3 percent, pre-HITECH, to more than 60 percent of eligible providers in 2013. Also, more than 80 percent of hospitals have invested in EHRs, he added.
“Yes, we have more work to do as we climb the meaningful use arc towards health information exchange, care coordination and patient engagement required in Stages 2 and 3,” Tang acknowledged. “But the laying down of an electronic infrastructure for the future is a salient milestone that wouldn’t have been possible without HITECH.”
John Halamka, MD, Beth Israel Deaconess Medical Center
John Halamka, CIO of Beth Israel Medical Center in Boston and a longtime standards guru, tends to focus his attention on the task ahead. But he has been thinking about the past recently.
“When I first became a CIO, my role involved writing applications and managing architecture at a detailed level,” he recalled.
However, over the past 17 years, he said, his role has become much more strategic. He’s had to make sure the right investments were made for BIDMC, that the right architecture was in place and that the resources were there to support it.
“I’ve had to master the political, communication and interpersonal skills of leading rather than the technical skills of being a strong individual IT contributor,” he said.
He’s had to do so, not merely as CIO of one organization, but also in his broader role in the industry. Halamka serves as chairman of the New England Healthcare Exchange Network and co-chair of the Health IT Standards Committee that advises the federal government. He is a full professor at Harvard Medical School, and a practicing emergency physician, not to mention that he and his wife Kathy are building Unity Farm, work that he chronicles regularly on his blog.
The work of the CIO and IT team has grown exponentially over the past 10 years, according to Halamka.
“BIDMC has grown by merger and acquisition requiring transformational IT solutions such as care management applications, population health analytics, community-wide HIE, big data management and mobile enablement for all our stakeholders,” he said.
BIDMC is not unique in finding itself in this position, and some can’t keep up.
“Demand and expectations have exceeded the ability of many IT organizations to keep customers satisfied,” Halamka said.
Scott MacLean, Partners HealthCare
Scott MacLean, deputy CIO and director of IS Operations, at Partners HealthCare in Boston, said he and his colleagues approach their work differently today than 10 years ago.
“We are not arguing that CPOE, electronic medication administration and other EHR functions are efficacious,” he said. “We are busy optimizing and measuring the results of these interventions.”
Just as CIOs and IT teams have changed how they look at their work, so have organizations. At Partners, which is in the midst of an Epic system rollout, MacLean says: “We realized that much of the functionality we developed is available commercially, so we’re adopting a vendor platform and will focus our innovation on genomics and other research discoveries we want to bring to the bedside and clinics.”
As he sees it, collaboration has taken hold across the industry, and interoperability is top of mind.
“In the past, healthcare systems sought to keep their patients’ information and HIT vendors wanted to sell all of their products to a provider, MacLean said. While that may still be the case at times, he said, “policy and payment models are driving collaboration, which will benefit consumers and save money.”
Collaboration is on Ed Ricks’ mind, too. Ricks, vice president and CIO at Beaufort Memorial Hospital in Beaufort, S.C., said, “I think it’s a very different skillset today. We’re collaborators now, working with the medical staff, and I’m trying to make the technology invisible to clinicians, and to open workflows. The technology is so cool right now and nobody has to care about the tech as much as what it does.”
George Hickman, Albany Medical Center
George Hickman, executive vice president and CIO at Albany Medical Center in New York State’s capital city, works as hard as he ever has over the past 10 years, but he has to be more strategic, he said.
“I move as fast as I ever did,” Hickman said, “but I am much more deliberate about priorities. I pay attention to what could be most beneficial, most costly and most risky – in both qualitative and quantitative terms.” This change, he said, is both intuitive and analytical, and it has come with experience.
As was the case with many other health systems across the country over the past 10 years, the biggest change at Albany Medical Center was the implementation of an enterprise-wide electronic health record system, Hickman said, and all the supporting, secure infrastructure and people change expectations.
Hickman foresees many more challenges ahead. “How we understand, use and even exploit our data will be our next ‘EHR-like’ challenge,” he proffered. “I expect that this frontier will take the same sort of time and teaching patience, may be somewhat costly, and will certainly be transformative.”
Harry Greenspun, MD, DeLoitte
“When you think back 10 years, at that time we had an industry way behind others,” said Harry Greenspun, MD, senior advisor at Deloitte’s Center for Health Solutions. “Stimulus and meaningful use gave us that push. It has created a tipping point of EHR adoption, now it’s actually happening and not just among brave innovators but bread-and-butter folks.”
As Greenspun sees it, pretty soon, if you can’t do a lot of simple things, like checking in at the doctor’s office electronically, it will be hard to remain competitive.
“My needs as a patient haven’t changed, but my expectations as a consumer have,” Greenspun said.
Geeta Nayyar, MD, PatientPoint
Call her a poster child for the health IT generation. When Geeta Nayyar, MD, chief medical information officer at PatientPoint, graduated from medical school in 2003, one of the things she looked for in a residency program was that the hospital had some sort of electronic medical record.
“Everything was paper-based – charts, labs, X-rays,” she recalled. She did not want to spend her time prowling around the bowels of a hospital to find patient information, she said.
By the time she started her fellowship, that hospital had a fully integrated EMR.
“We have this whole different ball game today where the EMR is basic and a lot of the graduating students don’t use paper charts,” Nayyar said. “In 10 years, we have come a very long way. It’s not just the infrastructure being laid. Even more important, it’s the application.”
What do you wish had gone differently?
CIOs don’t tend to be a coulda-woulda-shoulda bunch, but they don’t mind engaging in a little Monday-morning quarterbacking now and then. So, what might have gone better in the past 10 years to nudge U.S. healthcare to an even better place on the digital continuum?
“I wish we had made greater progress towards standardization – vocabularies, care practice, etcetera – and interoperability,” Spooner said. “I wish EMR products had opened to interoperability much farther than has been the case.”
For Halamka, it was without a doubt, “certification and overall program timing.”
“Part of the problem, as I’ve discussed previously, is that the certification criteria are overly burdensome and in many circumstances disconnected from the attestation criteria, requiring very prescriptive features that go beyond the intent of Policy Committee and Standards Committee,” he wrote in a Nov. 27, 2013, blog post, titled “Rethinking Certification.”
In that blog, Halamka discusses the benefits of “agile technology” over “waterfall technology,” which was the method used to derive the regulatory language and certification scripts.
“I’ve spoken with many EHR vendors (to remain unnamed) and all have told me that they created software that will never be used by any clinician but was necessary to check the boxes of certification scripts that make no sense in real world workflows,” he wrote.
In a November 20, 2013, blog post on fine-tuning the healthcare IT timeline, he wrote: “People are working hard. Priority setting is appropriate. Funding is available. The problem is that the scope is too big and the timeline is too short.”
On Dec. 6, 2013, CMS and ONC announced an extension to the meaningful use program.
“Under the revised schedule, Stage 2 would be extended through 2016 and Stage 3 would begin in 2017 for those providers that have completed at least two years in Stage 2,” acting national coordinator Jacob Reider, MD, and Rod Tagalicod, director of the CMS office of health standards and services, announced.
MacLean is on board with all the changes that have been required to move healthcare from a paper-based system to a digital one. But he wishes it could have been accomplished differently.
“I wish the industry could have reformed itself without government intervention and public spending,” he said. “I think it’s unfortunate that the myriad regulations stifle innovation in clinical care and payment models. Still, we have tipped the fulcrum on HIT adoption and I don’t think we’ll be going back.”
Hickman, at Albany Medical Center, said he wishes “we knew when to understand that something didn’t need to be invented here. We could have done more, and faster.”
Glen TullmanLooking to the future
Glen Tullman, former Allscripts CEO, turned venture capitalist and – as reported in Crain’s Chicago Business – creator of Ignite Glass Studios, a 20,000-square-foot, $5 million glassblowing facility he built in Chicago, continues to be bullish on healthcare IT.
“In the last 10 years, electronic health records have laid the foundation for everything that will change health and healthcare going forward,” he said, “just as computers paved the way for the apps that changed how we do almost everything in the rest of our lives. We’re closer than ever to enabling the intelligent, connected health consumer and, as in other industries, consumers equipped with information, mobility, transparency and access will change everything.”
He recognizes that many challenges remain, but he remains optimistic.
“As for those who point out what’s not working, those are just opportunities for health IT leaders to solve,” he said. “I believe we’re closer than ever to improved outcomes and bending the cost curve in the right direction.”
Spooner envisions a future – perhaps in 10 years – of smooth interoperability.
“Patient information will be interoperable across EMR systems, he said. As he sees it, the patient will be able to transport his full record from provider to provider irrespective of EMR choice. The patient will own the record and will enter/edit his own data to the EMR.
Also, “the U.S. will adopt a uniform patient identifier,” he added.
Compared to 10 years ago, Tang says, “I am more confident that the country will make the necessary paradigm shift from fee-for-service transactional care delivery to one focused on community health and wellbeing now that we are building the necessary information tools to support that transformation.
Denni McColm, CIO at Citizens Memorial Healthcare in Bolivar, Mo., recalls that it was 10 years ago – in December 2003 – that Citizens Memorial eliminated paper medical records.
“At the time, we thought everyone was doing the same thing, but found out over time that others were still just talking about it,” she said. “I’m surprised by how many hospitals still have paper medical records now. I’m thankful we were naïve enough not to know any better back then.”
Mulling it over today, she said, “It did teach us that following what everyone else is doing in IT is not always the best approach.”
Citizens Memorial Healthcare, a 76-bed fully integrated healthcare system, has never let its small size stand in the way of progress. In 2005, it was awarded the prestigious Davies Award from HIMSS, and in 2010, the health system reached Stage 7, the top level, on the HIMSS Analytics EMR Adoption Model scale.
MacLean’s high hope for the next 10 years of healthcare IT is that “we as consumer/patients will engage with the system and hold providers and payers accountable for quality and service.”
As for Halamka, he likens healthcare IT progress to air travel.
“When I became CIO in 1998, it was the Wright Brothers era of healthcare IT – building new technology was an amazing accomplishment,” Halamka said. “Today we’re in the biplane stage – solutions are commercially available but they are not agile or usable. I look forward to the Airbus 380 stage when the technology is safe, convenient, reliable and well engineered for purpose.”
Tang apparently prefers the train analogy.
“The journey, and work, is far from over,” he said, “but with the progress the country has achieved, the train is well out of the station, and we are well on our way towards a more adaptable and rational health system.”
HIMSS Media Executive Editor Tom Sullivan contributed to this article.
Topics: Meaningful use, Electronic Health Record (EHR), Policy and Legislation, Sharp Healthcare, Interoperability, Epic, Cerner, Intermountain Healthcare, James, Brent, Health IT Policy Committee, Health Information Technology for Economic and Clinical Health (HITECH) Act, Affordable Care Act, Health Information Exchange (HIE), Patient Engagement, Beth Israel Deaconess Medical Center (BIDMC), Health IT Standards Committee, Harvard Medical School, Big Data, Partners HealthCare, Computerized Physician Order Entry (CPOE), Electronic Medical Record (EMR), Centers for Medicare & Medicaid Services (CMS), The Office of the National Coordinator for Health Information Technology (ONC), Allscripts, Davies Award, , HIMSS analytics, Electronic Medical Record Adoption Model
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