|
|
May 29, 2006
The conclusion of For The Record’s electronic health record confab addresses the need for clear and powerful leadership. In our last issue, For The Record presented part one of a two-part roundtable featuring a cross-section of HIT experts, including vendors, government representatives, and consultants, speaking about the obstacles to launching a wide-scale deployment of an electronic health record (EHR). In part two, we focus on who should be driving efforts to expedite wide-scale deployment, who needs to step up to the plate, and the impact activities at the federal level have had on moving the process forward. The participants are (in alphabetical order) as follows: • Marv Addink, CEO, SolCom; • David Brailer, MD, PhD, former national coordinator for HIT, Health and Human Services; • Sarah T. Corley, MD, FACP, chief medical officer, NextGen Healthcare Information Systems, Inc.; governor, Virginia Chapter, American College of Physicians; • Todd C. Cozzens, CEO and vice chairman, Picis; • Kathleen LePar, RN, MBA, manager of consulting services, Beacon Partners, Inc.; • Dan Michelson, chief marketing officer, Allscripts; • Michael Raymer, senior vice president and general manager of the IDX Carecast Operating Unit, GE Healthcare Integrated IT Solutions; • Charlene Underwood, chair, HIMSS Electronic Health Record Vendor Association (EHRVA); • Andrew G. Ury, MD, CEO, Practice Partner; and • C. Peter Waegemann, CEO Medical Records Institute; chair, Mobile Healthcare Alliance. Taking the Lead David Brailer (DB): “First and foremost, it has to be physicians. Purchasers, payors, and government can be very supportive, but if doctors don’t want to go there, it’s just not going to work. These tools require substantial changes in clinical practices, in culture, in the way a practice operates, and you can’t force that on doctors. Doctors have got to be first in line, but then all the [other] groups have to be right behind them. There’s no single group that can just make this happen. Government has a big share of the market and has a lot of the regulatory power, but it alone can’t do it unless it chooses to do a mandate, which is something we’ve said we’re not pursuing.” Todd C. Cozzens (TCC): There “needs to be a partnership between vendors, hospital administrators, and staff. Vendors need to continue to invest in research and development focusing on the clinical and operational needs of healthcare organizations, both now and in the future; administrators need to invest in technology and provide the resources and education needed to install EMRs [electronic medical records] properly and continue to optimize their success over time.” Dan Michelson (DM): “The easy answer is not necessarily the right answer. Many have assumed that the federal government should drive this change. However, our view is that they are in more of a position to facilitate vs. mandate. For example, they have done an excellent job in bringing the industry together to accelerate interoperability. With that said, interoperability is not at or near the top of the list in terms of buyers’ concerns related to EHRs, but it is an important component of the long-term value proposition. “We believe that the most critical stakeholder to engage in this process is the physician, and that physician leadership will ultimately be the primary contributor to widespread adoption of EHRs. Most of the focus in the national discussion is on adoption, but the real story is utilization. As we say at Allscripts, ‘If the doctor doesn’t use it, nothing else matters.’ That’s not to say that all stakeholders aren’t critical, only that if the physician doesn’t use the system, all of the promise of healthcare information technology will be nothing more than a promise.” Charlene Underwood (CU): “Public and private collaboration is essential. Groups like Connecting for Health are a model of the type of collaboration that can move agendas forward. HITSP [Healthcare Information Technology Standards Panel] is another agency well positioned to provide multistakeholder views and ultimately set direction. Since so much progress depends on mastering the details of achieving successful data exchange, grassroots knowledge is extremely valuable in defining rational approaches to building interoperable healthcare. Government should leverage its learning from such programs and experts in order to set direction.” Andrew G. Ury (AGU): “There can’t be one leader in this effort; several different parties have to step up. Physicians and the physician community have to continue to step up to understanding and being educated on why this is important; the payor community, both public and private, needs to move more quickly toward providing financial incentives. We need to continue to make interoperability standards easier and faster and that requires an effort by lots of parties.” Government Efforts DB: “To be very candid, there’s a lot more we could do. We could say, ‘We’re going to mandate these tools.’ On the other hand, I think things like that that are draconian, that are very top-down, might force these technologies into use, but would not achieve the quality and efficiency goals that we have. So we’ve tried to use government’s role as a catalyst, government as a lead driver, government as an educator, and government as an enabler in a sense that there are some regulations that are in the way of this happening. One example is Stark and anti-kickback rules that prohibit the kinds of collaboration that’s needed to improve care in some cases like health IT. “Given that role of being the catalyst, an enabler, and a leader, we’re really doing everything that we really feel could be done in a reasonable way. It’s a very organic process, but we’ve got a whole hand of cards in play here, and I think they’re playing out in the way that we want.” TCC: “There are more than 18 pieces of bipartisan legislation calling for faster adoption of IT in healthcare. The formation of [Health and Human Services Secretary] Michael Leavitt’s American Health Information Community [AHIC] will help advance interoperability by establishing standards for interoperable EHRs. Vendors need to get away from information silos and stop talking about interoperability and start delivering it today. The government and AHIC can provide incentives to get others on board faster.” DM: “Many government initiatives have been put in place and they are certainly bringing a great deal of attention to EHRs. It appears that every group has either implemented, is in the process of implementing, or is planning on implementing an EHR in the near term. With that said, many of the federal government initiatives have been more focused on ‘laying the tracks’ as it has been described by Secretary Leavitt. These are important initiatives for the long-term architecture of the national health information network as well as for regional- and community-based initiatives, but they don’t have a significant impact on driving a physician practice to purchase an EHR today.” Michael Raymer (MR): “The federal government has been timid in its approach to providing incentives for the adoption of EHR systems. In the 1950s, our government made a significant investment in our freeway system as a tool to speed the evacuation of a region of the country in the event of a nuclear attack. Those freeway systems also served the dual purpose of speeding the transfer of goods across this country. A nationwide implementation of interconnected EHRs will be a critical tool in the containment of a pandemic flu or bioterrorism attack. EHRs would also serve the dual purpose of reducing the cost of healthcare while improving quality of care delivery.” CU: “The focus on standards is on target, but the processes being employed are not necessarily the most effective. Similarly, the development of regional healthcare efforts is important to achieving health transformation, yet we don’t see a depth of collaboration in the processes directed by government. Decisions appear to be made with limited consideration to who really needs to do the work. “Using a more empowering approach would make alignment, buy-in, and commitment more achievable. In part, this is because in instances such as the AHIC member distribution, for example, we seem to be seeing the balance of public and private collaborators being skewed toward the public space.” The ONC DM: “Since the announcement of the Office of the National Coordinator for Health Information Technology, there has been great traction in healthcare IT and Dr. David Brailer and his team deserve a great deal of credit. The bottom line: He developed a plan and then methodically implemented it. It is amazing to review the original strategic framework that he provided—it is a precise roadmap of the trail he has taken and everything that has occurred since. “ONC has not been the only driver. However, there is no question it has been a significant driver in terms of bringing attention to the industry, bringing together the stakeholders, and accelerating the decision-making process.” Kathleen LePar (KL): “We need to see the fruits of their labor. The healthcare community will be more apt to adopt EHR implementation if the guidance is provided. Consumers must also be provided with awareness regarding EHR so that they can be part of this process as well as an impetus for movement.” MR: “David Brailer has done an excellent job of creating a national dialogue about the need for widespread adoption of EHRs. The greatest challenge, however, has been the engagement of Congress in crafting legislation that spurs the adoption of EHRs. The rhetoric at the executive branch has not resulted in either funding or legislation. In the first year of David’s office, the small budget for his department was not even funded by Congress [yet] anyone attending the HIMSS show in February could see the impact of David’s office on private industry.” CU: “We are somewhat discouraged. Dr. Brailer[’s successor] needs to promote the value of accomplishing interoperability—[he or she] needs to reinforce to the market that interoperability is a market force that can be leveraged for the benefit of all. This will enable [him or her] to make substantive progress toward [his or her] agenda. The equation is straightforward—customers want interoperability and their demand drives the vendors to build appropriate functionality. This, in turn, drives the market to move.” C. Peter Waegemann: "The ONC has done a good job in a very difficult situation. However, it needs to be more open to consider business considerations regarding the NHIN. In particular, it needs to be more open to the Continuity of Care Record and the buy-in of the medical specialty organizations. “There is too much emphasis on the claim that small practices aren’t ready, rather than helping them to master the difficult situation of planning, selecting, and implementing an EMR. The certification process encouraged by ONC and the use-case scenarios of ANSI and HITSP do not promise success at this time.” Others Need to Step Up Marv Addink (MA): “This is one of the areas where healthcare organizations, whether [it be] HIMSS, AHIMA, JCAHO, or other official bodies, could do a better job of really analyzing the direction we should go. I think there are a lot of good things that are happening at some hospitals … that do specific portions of the EHR really well, and sharing that information, discussing how it was accomplished and the benefits of that accomplishment, would motivate a CFO [chief financial officer] or CIO [chief information officer] of a hospital to move in a similar direction. That doesn’t need to come from a vendor’s standpoint or hospital’s standpoint, but from an organization’s standpoint that really is neutral.” DB: “I would love to see consumers
be highly involved in this. It’s about their healthcare, their
health information—decisions that affect their lives and economic
welfare. Consumers are just starting an era of major consumerism in
healthcare, so we do have a lot of consumer engagement from different
groups. But frankly, I don’t think there could be enough in terms
of them really shaping this. There’s a tendency in healthcare
for doctors, hospitals, nurses, payors, purchasers—the usual suspects—to
get together and say they’re going to fix something for their
patients, but not with their patients. TCC: “Healthcare IT companies need to stop talking about integration … and start doing it. Implementing a widespread CPOE [computerized physician order entry] is hard and too many vendors make it harder for hospitals by buying systems and using duct tape to put them together as an EMR rather than considering ease of use, speed, and patient safety.” DM: “Physicians are the key—individually and collectively. This is where the rubber meets the road. It is critical that members of EHRVA have a seat at every table in this process and that the industry fully leverages their expertise.” KL: The “AMA [American Medical Association] and ANA [American Nurses Association]; this needs to be about quality of care.” MR: “A number of states have been much more aggressive than Congress in spurring the adoption of EHRs. Hopefully, successes at the state level will spur increased attention by Congress to critical legislative initiatives.” AGU: “Private payors, the insurance industry, should be taking a much bigger role than it has up till now.” Parting Shots “Currently, healthcare employs the most individuals in the U.S. than any other industry. Yet it is one third to one fourth of revenue of other industries like distributing and manufacturing. Typical community hospitals could employ 5,000 to 8,000 people and be the largest employer in the community. That’s nice to be the largest employer, but that also is a huge expense. We need to start looking at the productivity of those 5,000 to 8,000 people and see what can be done to control that expense.” DB: “What’s really at stake is not just if [doctors] are using a technology, but if they’re using electronic health records that really improve healthcare, that have the kinds of decision support built into them that can improve their decision making, the kind of capacity to share information and make it seamless and portable for patients. I don’t take that for granted at all. It’s up for grabs whether [EHR] is just an office technology like a fax machine or a convenience factor for the doctor—and lord knows doctors need it—or if it is a real life saver. “A lot of our efforts around interoperability, certification, developing architectures, and new privacy modalities are all built around not driving the inevitability of this technology—because I think the culture will take care of that for us—but on making sure … that it’s a tool that delivers on the promise.” Sarah T. Corley: “Healthcare delivery is a highly regulated, complex process. This must be considered when discussing EHR deployment. All parties involved must realize that physicians cannot just raise their fees to cover the cost of technology while payors and government limit reimbursements.” TCC: “The biggest, fastest ROI [return on investment] of any [HIT] initiative is in the high acuity care area. The extremely complex and diverse needs of physicians across the healthcare setting remain formidable barriers to IT adoption because a system that works well on a medical ward won’t meet the needs of physicians in an emergency room or an outpatient setting. Meanwhile, patients are dying while everyone is deciding what to do. “Hospitals can start realizing benefits and improving quality and efficiency rapidly by installing one integrated system that covers the entire perioperative process first—creating an electronic record from scheduling to preoperative testing all the way through surgery, post-acute care, to discharge. The goal being that the perioperative system will immediately impact patient care and deliver clinical and financial improvements with a comprehensive electronic patient record, and this clinical documentation can then be integrated eventually into the overall health record.” DM: “This is truly an inflection point, not just for electronic health records, but for healthcare in general. Very shortly, it will be hard to remember when healthcare was paper-based. Change sometimes comes slowly, but ultimately it feels like it happened overnight. Technologies such as cell phones, cash stations, personal computers, the Internet, and, even most recently the iPod, took some time to become standards. But, when they did, they transformed not only industries, but, in many ways, how we live. That’s really the story here. It’s not about the technology—it’s about changing healthcare.” MR: “It is critical to the future of this country that we improve the efficiency and quality of our healthcare delivery system. Information systems must play a critical role in this process. If we do not stem the cost of healthcare for this country, we will no longer be competitive in the global market for goods and services.” CU: “I have been amazed at the degree and willingness of the HIT vendor community to step up and address and commit to investment to achieve a higher goal for the industry. Leadership that enables the right processes to capitalize on this energy and synergy is crucial to effectively achieving IT-based health transformation so desperately needed by our country.” AGU: “I do believe that electronic health record adoption is very important for the U.S. Given the level of electronic record adoption in all segments of our society, it’s somewhat amazing that the doctor’s record remains a bastion of paper. “The second thing is that I do believe it’s coming, and that the market and physicians are beginning to recognize this. Increased adoption is beginning. The question is how to accelerate it. To get there is going to require a lot of cooperation between the EMR industry with the federal government, private payors, and with physicians themselves.” — Elizabeth S. Roop is a Tampa, Fla.-based
freelance writer specializing in healthcare and HIT.
|
 |