1. Health should be at the heart of health IT
With billions of taxpayer dollars about to be invested, the stakes are indisputably high to set the right priorities for accelerating the benefits of health information technology. What should those priorities be? It would be easy to assume that the main focus should be on technology-related issues—standards, software, hardware, technical support, and so forth. After all, isn’t “IT” what we are talking about? But technology-related goals often seduce and distract us from the heart of the matter. Ironically, one of the biggest obstacles to expanding the use of health IT may be a narrow focus on stimulating its adoption. Success is not how many doctors and hospitals use electronic medical records. Success is when clinical outcomes improve. Success is when everyone can learn which methods and treatments work and which don’t in days instead of decades. Now that the federal government is investing upwards of $30 billion to help stimulate health IT adoption among providers and hospitals as part of the American Recovery and Reinvestment Act (ARRA), it’s critical that we define success in the right wayWe must use health IT as a tool to transform the US health care system as a whole, rather than simply computerizing the current setup. Indeed, the literature on computerization, stretching back to the 1980s, is unambiguous on this point: computers are amplifiers. If you computerize an inefficient system, you will simply make it a faster inefficient system. IT can improve the quality of care only when underlying system processes are transformed at the same time. So, the heart of the matter is that health IT investments must be directed toward three clear and unwavering goals: improving health, protecting privacy, and slowing the unsustainable spiral in costs. In fact, a reason health IT subsidies were included in an omnibus law addressing the economic crisis is policy makers’ high hopes that IT will help our ailing health care system rein in spending growth while improving quality.
What Matters by Carol Diamond and Josh Lemieux
The Health IT Policy Committee approved revised recommendations for defining "meaningful use" of electronic health records this past Thursday. But for many providers—especially rural community hospitals and solo or small group practices—the objectives for meaningful use are still out of reach. The bar needs to push providers, while ensuring that a reasonable number of leading-edge organizations can achieve it by 2011, says John Haughom, MD, senior vice president of clinical quality and patient safety at PeaceHealth, a Bellevue, WA-based seven-hospital system with a 500-member medical group. Haughom is no stranger to HIT. Roughly 14 years ago, PeaceHealth implemented a community health record that shares patient information with providers throughout the region—including its competitors. The community health record has roughly 2 million patient records in its database and more than 20,000 clinical users—only a portion of whom are PeaceHealth employees. CPOE. The recommendations call for 10% of all orders of any type to be directly entered by an authorized provider through CPOE by 2011. Haughom wants that bar lowered even further. "I'd cut it in half down to 5%," he says. "That means organizations that are reasonably close–even if they haven't implemented CPOE—could launch pilots and have a chance of hitting it," he says. Haughom would prefer the timeline for CPOE to be something like 5% in 2011, 10% or 15% in 2012, and so on. Electronic problem list. Providers and hospitals must maintain an up-to-date problem list of current and active diagnoses based in ICD-9 or SNOMED by 2011, according to the recommendations. The challenge with the electronic problem list is who owns and manages the list is always a matter open to debate, says Haughom. Personal health records. The 2011 recommendations call for physicians and hospitals to provide patients with an electronic copy of their health information, including lab results, problem lists, medication lists, and allergies upon request (hospitals must also provide discharge summary and procedures). One element that both physicians and hospitals are happy about is the revised timeline, which gives them more time to meet the EHR "meaningful use" criteria. If providers want to receive full reimbursement, they need to have systems in place in the first two years of the program.
HealthLeaders Media by Carrie Vaughan July 21, 2009
3. Duke-Durham partnership: Informatics improves health
Medical informatics is playing a significant role in a unique, newly-launched partnership between Durham-based Duke University and the Durham, NC, community. The goal of the partnership, known as Durham Health Innovations (DHI), is to improve the health of everyone living in Durham County by using medical informatics to identify interventions for community members whose needs aren't being met successfully by conventional methods. "The informatics side of this project is deeply embedded," says Lloyd Michener, MD, chair of the department of community and family medicine at Duke. "The entire project requires a very robust backbone and system. This is an example of what you can do with really good information systems and analytic tools. You're basically doing real-time epidemiologic studies." The data the partnership uses comes from Duke University's electronic medical records (EMR) system, which is a variation of the system developed by San Francisco-based McKesson. Duke has implemented the system in all of their office practices. The university collects the data from the EMR and runs customized software on it that assigns geographic locations to the data, also known as geocoding. This process, which is HIPAA-compliant, allows them to look at areas of disease clustering in order to treat specific diseases or disorders prevalent in areas within the community.
HealthLeaders Media by Cynthia Johnson July 20, 2009
4. Health information exchanges see 40% growth from previous year
The number of community-based health information exchanges (HIEs) that transfer data electronically among physicians, hospitals, health plans, and patients increased by nearly 40% from the previous past year, according to the new sixth annual survey and study released by the nonprofit group, eHealth Initiative (eHI). Approximately 193 active initiatives are now involved in HIEs across the country and 153 participated in the survey. Among the different stakeholders in those HIEs, hospitals (21) and physician practices (19) were anticipating to see returns on their investments during this year, according to the study. Cost savings resulting from HIEs were reported by 40 operational HIEs in the following areas: Reduced staff time spent on handling lab and radiology results (26 initiatives); reduced staff time spent on clerical administration and filing (24); decreased dollars spent on redundant tests (17); decreased costs of care for chronic patients (11); and reduced medication errors (10).
HealthLeaders Media by Janice Simmons July 23, 2009
5. Six must-know tips to implement an effective HER
The incentive money is there to implement EHRs, but most HIM professionals and hospital executives know that deploying the technology is not as simple as pressing a button to go live. Several industry experts have weighed in on this question: What is the single most important tip you could provide to someone regarding an effective EHR implementation? Their answers, summarized below, are quite telling.
Tip #1: Realize that the EHR will not solve your problems. "EHRs do not necessarily fix poor processes, but rather, they tend to expose them.
Tip #2: Identify EHR stakeholders and involve them in the implementation process.
Tip #3: Keep it simple with as few systems as possible.
Tip #4: Remember that communication is essential.
Tip #5: Recognize that paper will never disappear completely.
Tip #6: Keep usability in mind.
HealthLeaders Media by Lisa Eramo July 23, 2009
6. Robot will be Rx for Grady’s long prescription waits
People have come to expect waiting hours to fill prescriptions at the Grady hospital pharmacy. It means long hauls on hard seats, and for some needy people who go there, it feels demeaning. But Grady officials are moving forward with plans to revamp the outpatient pharmacy, investing $2.6 million on something they say can reduce wait times: a robot worker. Grady officials this month approved the purchase of the robot, which can stock 720 drugs and process 550 prescriptions an hour. The robot is expected to be running by November. Moreover, the hospital is shifting some of the pharmacy pickup sites to a building about two blocks from the hospital.
AJC by Craig Schneider July 23, 2009
7. Your medical information in the digital age
The U.S. is moving toward electronic health records. Here’s how to make that work for you.
You probably take for granted that you should manage your own résumé. After all, it catalogs your professional history and accomplishments—who else would manage it well? But chances are you don’t oversee your own medical records. Until now, doing so has been difficult because bits and pieces of your information are probably scattered across the files of several doctors, hospitals, labs, and pharmacies. That’s an inconvenient—and potentially dangerous—state of affairs, but one a new federal law may help to remedy. The American Recovery and Reinvestment Act is providing about $30 billion to improve the exchange of health care information. One trickle-down effect will likely be greater access to your lifetime medical information through a personal health record in electronic form. The underlying idea is simple: Compiling your medical data in one place lets you be the steward of your health information. Like first writing up a résumé, creating a personal health record takes time, but there are several payoffs. Having the record can prevent unnecessary testing and treatment (and, in turn, save you money), reduce the chance of a medication error, and instantly provide vital information in an emergency. It also can be used to keep track of your weight, blood sugar, and much more. So far, four types of electronic personal health records are available: 1) Hospital- and clinician-hosted records are great if all your information resides at a single institution. 2) Payer-hosted records, such as HPHConnect from Harvard Pilgrim Health Care, give you access to claims information relating to your medications, doctor visits, and hospitalizations. 3) Employer-sponsored records are typically hosted by a trusted outside firm, creating a firewall between the employer and the medical data. 4) Commercial offerings, such as Google Health and Microsoft Health- Vault, allow you to link to your electronic records stored at participating hospitals, pharmacies, and laboratories. What about privacy? Each of these products has strict policies stipulating that the host companies will not mine personal health data, share them, or use them for targeted advertising. Hospital and payer data are covered by rules in the Health Insurance Portability and Accountability Act of 1996. Google’s and Microsoft’s offerings are outside HIPAA’s scope, but both firms have developed policies that are even stronger than the legislation mandates. I trust those policies enough to have stored my lifetime medical record on Google Health and Microsoft Health- Vault. This new world of connected health care has tremendous potential to increase both personal and systemwide efficiency.
Harvard Business Review by John D. Halamka, M.D.