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Readers Write 8/3/11

August 3, 2011 Readers Write 2 Comments

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

The Pressures of EHR Adoption and a Market Trend of Converged Services and Technology
By Janet Dillione

8-3-2011 7-26-22 PM

Recent mergers and acquisitions in the healthcare information technology (HIT) industry bring to light many facets of electronic health record (EHR) implementation that often go overlooked. As many in the medical industry know, implementing an EHR system so it works seamlessly with clinical workflow is more complicated than downloading and installing software with the click of a mouse. There is not an EHR switch that can simply be turned on.

Healthcare organizations that have successfully implemented EHR systems, along with those currently navigating the process, can attest to the need for a scalable system wide approach. To achieve improvements in the quality, safety and efficiency of patient care special attention should be paid to services and technologies that foster EHR adoption across the clinician population.

Recent strategic alliances in the healthcare IT space signify a movement toward a promising future of EHRs, a future with a genesis in advanced clinical documentation. A successful, long-term EHR strategy, one that will position healthcare organizations to overcome the many pressures of the healthcare industry in the years to come – Meaningful Use, ICD-10, Accountable Healthcare – begins with effective data capture. The reality is that an EHR is only as good as the information captured within it, and as the saying goes, it takes a village …

I have no doubt that the industry will continue to see more strategic partnerships. These alliances establish greater resources for the healthcare industry, leading to more streamlined workflows, greater cost savings, satisfied physicians, and improved quality of patient care. However, none of this happens overnight and healthcare organizations should see this as an evolutionary process, not one of instantaneous change. By this I mean, every provider setting has a clinical documentation workflow in place, and pursuing an approach that is diametrically opposed to the status quo can prove counterproductive to the effort.

Despite the enthusiasm for employing state of the art technologies, healthcare organizations should not feel pressured to immediately make all data capture mobile, to put all applications in the cloud tomorrow, or to force doctors to use an EHR without a safety net out of the gate. In time, the increased amount of service and technology convergence across the industry will help healthcare organizations to better address the pressure of EHR adoption, and more importantly, will help them better manage their robust collections of clinical data.

It is becoming increasingly clear that in healthcare, data is knowledge. It drives care decisions, billing and reimbursement, compliance with federal regulations, and is key to overall health system improvement. Today, there is no one solution, no one vendor, and no magic potion that can address all of these issues and capitalize on all opportunities. However, by strategically bringing together the best in technology with the best in services, healthcare organizations will be better positioned to make the transition from traditional workflows to the EHR in a thoughtful, natural way.

An impressive amount of progress has been made over the last several years, particularly in light of EHR adoption pressures. Innovation and automation is transforming the processes and outputs of clinical documentation. What once was scribbled on a notepad, created on a typewriter, or passed from caregiver to caregiver in the hallway, is captured and transferred more efficiently and effectively than ever before. Such effective clinical documentation establishes an important foundation for EHRs.

By leveraging and contributing to technology collaborations, healthcare organizations can access the best in services and technology. This means a transition from handwritten records stored in manila folders to digital information stored within EHRs captured through natural clinical workflows. Moving forward, there will be multiple ways to capture the patient story including keyboard input and speech-to-text technologies.

Once clinical information is captured, we’ll see the application of highly intelligence clinical language understanding (CLU) technologies, often referred to as natural language processing or NLP in other industries. These highly sophisticated technologies will turn our vast amounts of clinical data into knowledge to be leveraged across the healthcare ecosystem.

The convergence going on across the healthcare industry amongst healthcare IT vendors, academic centers, service-oriented businesses, and other organizations is promising, but should be scrutinized by healthcare organizations.  There are many promises amongst the recent M&As and partnership activity, but only few proven results and long-term plans.  As you work to tackle EHRs as a strategic initiative, enlist supportive guidance and build a nimble infrastructure where the EHR can become a launching pad for better use of data.

Janet Dillione is EVP/GM of the healthcare division of Nuance of Burlington, MA.

Meaningful Use and Innovation
By Ryan Parker

All human development, no matter what form it takes, must be outside the rules; otherwise we would never have anything new. – Charles Kettering.

I have recently finished up some consulting work for a startup HIT company (which for non-solicitation reasons I will refer to as Company X.) I was working with them to help develop their EMR. 

When Company X first showed me their product, I was amazed. In just over a year, they had developed an almost fully functioning EMR. Using more advanced coding language than what you would find in most legacy systems (i.e. C#, Silverlight) they came as close to mimicking the clinical workflow as I have seen with an information system.

Everything was looking up. Their product was becoming more and more complete and becoming more and more advanced. But then they ran into an issue. If anyone has worked with or been a part of a start-up, momentum is key to success, and in this company’s case, the Innovation truck slammed head first into the Meaningful Use wall.

To be completely honest, forcing Company X to get their product Meaningful Use certified did have some benefits. There were some system needs they hadn’t thought of previously. In terms of HIE and interoperability, the requirements will have a positive impact as a whole as we move to a more ‘data-sharing’ driven information system structure. However, the innovation, creating a system different from anything else, which, to keep the truck metaphor rolling, was sitting in the driver’s seat of the company, dissipated as executives and engineers dived deeper and deeper into the ONC requirements.

Weeks turned into months of working on the Meaningful Use requirements. Although Company X was making progress, the focus slowly turned from creativity and ingenuity to one of conclusion, as in, “How soon can we meet these requirements and be done with this product?”

Soon, the executives starting turning their attention to other products, focusing on solutions that fall outside of the ONC/Meaningful Use umbrella.

I have no doubts that after they complete their Meaningful Use certification in the near future, and hospitals and health systems get a good view of their product, Company X will receive accolades on their HIT advancements from the healthcare community. Personally, I will be wondering what progress could have been made without standardization. What advancements could Company X have made without the rigors and requirements forced upon EMR vendors?

Ryan Parker is implementation practice director of Preceptor Consulting Corporation of Fort Myers, FL.

HIEs: High Performers Will Be Around for the Long Term
By John Haughton

8-3-2011 7-13-51 PM

Improved patient care outcomes, lower administrative costs, fewer medication errors, improved ability to manage chronic conditions, reduced unpaid re-admissions, greater efficiency, fewer ER visits …

There is no question about the benefits that a highly effective health information exchange (HIE) brings. By highly effective, I mean a healthcare ecosystem grounded in evidence-based medicine, clinical guidelines, and performance reporting.

For providers hoping to achieve Meaningful Use (MU) or to become Accountable Care Organizations (ACOs), performance-based HIEs hold the promise of pulling together data from myriad sources — medical staff and community physicians, insurers, labs, imaging centers, behavioral health and home health providers, employers, consumers, retail pharmacies — to finally deliver truly coordinated care.

But there is also no question about the challenges facing fledgling HIEs, the primary one being a sustainable business model. It turns out that, if you build it, they won’t necessarily come. And once the grant money runs out, the organization rapidly runs out of steam.

The only way to build an HIE with enduring power to transform the health of a community is to have providers pay for it. And the only way to do that is to provide high value — quickly. This means demonstrating value from Day One by raising the bar on clinical quality for their customers, namely, patients.

In response to the MU requirement for value-based purchasing and market realities pushing margins into negative territory for about half of all hospitals, HIEs must help hospitals survive and thrive in the new patient-centric business model to garner lasting provider support.

The HIEs that have done this successfully have something in common: they pretty much all have their heads in the cloud, which is to say, they use platform-as-a-service (PaaS) cloud computing technology that offers authorized users easy, but extremely secure access to centrally stored, actionable information for an affordable price.

Here are the seven technology elements needed to play in the high-performance league:

  1. Maximum functionality and flexibility. Since around three-quarters of healthcare in this country remains paper-based, technology is needed that supports hospitals and physicians regardless of their technology sophistication. This favors best-of-breed EHR modules that can meet a wide variety of needs, budgets and timetables, rather than a comprehensive, enterprise-wide approach.
  2. A full range of value-added tools and services. Think of the app store on an iPhone. That type of flexibility and customization are what is wanted from HIEs, only instead of YouTube, GPS, and Fandango, apps that provide clinical decision support, performance management, quality reporting and analytics, clinician messaging, shared guideline dictionaries, and disease registries are valued.
  3. On-the-fly translation. As long as stakeholders continue to speak different electronic languages — all of which are upgraded and updated almost constantly — mapping and translation services are needed for interoperability.
  4. Scalability. An HIE is a dynamic entity; it needs a platform that continually accommodates more of everything: providers, users, technologies, regulations… Collaborating across town is great. Collaborating anywhere is the ultimate goal, however.
  5. Ease of use. An identity federation service means providers need just one user name and password to interact with each other, health plans, regulators and patients — and just one point of access for all clinical and administrative data held by the HIE.
  6. A 360-degree, real-time view. A single, comprehensive view of a patient’s status, including all information submitted by all authorized sources from five decades ago to five minutes ago, will help eliminate redundant tests and procedures.
  7. Sharing of best practices. The best HIEs aren’t merely repositories. They must be able to analyze input, generate point-of-care solutions, and disseminate data that draws on documented successes.

So the future is bright for those high-performance HIEs that “bring it” — clinically speaking. HIEs and other data exchange organizations that figure just having the data will have hospitals and physicians beating a path to their door are being naïve and are putting their long-term survival at risk.

Like it or not, healthcare is a business as well as a service, and organizations need to deliver ongoing value to ensure their long-term relevance and sustainability.

John Haughton MD, MS is CMIO of Covisint of Detroit, MI.

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Currently there are "2 comments" on this Article:

  1. All three essays are interesting. However, they each gloss over one important point. The safety, efficacy, and usability of these complex devices has yet to be determined, despite the government’s pressure to adopt, and adapt to the impediments posed by these systems.

    The US should study the UK Programme for HIT that was recently scrapped in order to not continue to waste our money while patients suffer.

  2. These are insightful perspectives on EHRs and meaningful use. I’m wondering how all this will play out for radiologists and other specialists who are eligible for MU bonuses but also subject to individual penalties if they don’t comply.

    I doubt hospitals can be counted on to create MU-certified EHRs that will get radiologists their bonuses. So what are specialists to do?

    I’d welcome other perspectives on this.


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