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Making the Most Out of HIT in an Ambulatory Care Setting
By David Christianson

It's a new day for IT in ambulatory care in part due to government health care quality initiatives and the trend from fee-for-service to value-based reimbursement contracts. Technology-driven health care innovations are emerging at a rapid pace to address quality initiatives and to support reimbursement models using EHRs.

For instance, changes to provider reimbursement models require changes to EHR platforms, which can often necessitate IT changes—network infrastructure optimization, hosting and datacenter modifications, and new devices—mobile or otherwise—at the edge. The complexity of these changes and new requirements can often appear overwhelming from an IT perspective. The need to consider workflow and clinical outcomes at every step of the way further complicates IT planning in the ambulatory environment.

The Tension Between Quality Care and Efficiency
Providers are faced with the unenviable and seemingly impossible task of balancing care for their patients with maintaining efficient and cost-effective operations within individual practices. The overwhelming requirements of reimbursement systems, payer rules and federal, state, and professional compliance have created an environment that can increase the time required to simply run the practice.

Providers are increasingly frustrated by the burdens these requirements place on their time. That frustration is often magnified by the fact that EHR platforms and associated technology do not perform effectually, reducing time spent with patients and necessitating more time be devoted to ancillary data and business tasks.

HIT: Effective, Efficient Steady-State Operations
The ultimate goal of any good IT operation is achieving and maintaining steady-state operations. All too often, IT organizations get caught up in the challenge and rush of change. Granted, change is a constant in IT. However, good IT managers understand the need to define what a "steady state" looks like for their users and consider what must be done operationally to insulate those users—those clients—from the pain and pitfalls of change.

Striking a balance between managing the patient care and business sides of any medical practice includes equalizing technology use and technology support. The benefits of any number of technologies can be achieved through good planning and effective professional implementation. What is often lost in the planning equation is emphasizing the considerable cost and operational burden of effective IT administration and support. The ambulatory environment presents unique challenges for many internal HIT organizations. The highly variable size and distributed nature of medical practices—whether owned or affiliated—require specific approaches to end user support, network administration, and data center operations.

Central help desk/contact centers—whether owned or outsourced—can most effectively accept and triage IT issues. That single-point-of-contact approach to all IT support provides a fundamental ease-of-use benefit for providers who are striving every day to ensure their "face time" with their patients. Having a single point of contact to help facilitate issue resolution of not only IT but also EHR issues can save precious time for providers and practice managers.

As in medicine, the rapid triage of IT issues ensures that problems are prioritized and assigned with maximum efficiency. The goal is always to resolve a high percentage of problems remotely, but any support organization has to provide for on-site support when required. Quick dispatch of those onsite resources is another fundamental requirement for optimal HIT support.

Customized Solutions for HIT
Utilizing an outsourced health care data center to support an aggregated network of physician practices often proves to be both efficient and cost-effective. EHR platforms are effective only when they are available and performing well. Core IT operations principles—high availability, reliability, security, redundancy, and extensibility—apply here.

A quick, secure, and easily scalable health care data center solution can ensure health care practices are well supported. For instance, with health care's strict data retention policies and increasing demands for high-capacity data storage capabilities, having a scalable storage and outsourced data center is good practice. In environments where the central IT organization is hosting an EHR, outsourced backup and disaster recovery can provide the necessary capability and flexibility to ensure business continuity and compliance.

Gone are the days of one size fits all. Ambulatory practices are seeing a growing need to utilize a variety of HIT services to increase efficiency in the office setting and improve patient satisfaction and outcomes as well as achieve their business objectives in order to thrive. In the event of a possible hardware malfunction, site failure, or event error, maintaining uninterrupted data accessibility is essential.

IT Resources for an Ambulatory Setting
With health information exchange, PHRs need to be shareable between health care providers such as private-practice physicians, home health agencies, hospitals, and nursing care facilities. This is where an HIT services company can make a difference. For instance, since EHRs have been widely implemented, medical practices have successfully gone paperless; access to patient data is amazingly convenient when it is working and amazingly inconvenient when it is not. Unfortunately, IT can become a barrier in an ambulatory setting with patient care.

Providers need to be assured that their computers will work properly; they want to avoid entering an exam room, trying to log in, and finding that they can't because the Wi-Fi cuts out. They end up spending too much time trying to get what they need on their screens. Mobility in particular presents a whole range of IT challenges that need to be met before applications are implemented or upgraded.

If core IT infrastructure is inadequate, the best applications in the world have no hope of being effective. No one likes to hear the four words, "The system is down!" This is usually accompanied by some angry four-letter words that, although somewhat liberating at the time, unfortunately do little to solve the problem.

Struggling with administrative responsibilities diverts time away from patient care, and then there is the insurmountable amount of data entry that needs to happen to receive reimbursement for health care services. Doctors are overworked—we now all too often hear the term "pajama time." Providers are spending too much time after hours—after the patients have left the practice—to complete the administrative tasks associated with EHR and payment requirements.

In Conclusion
With the rapid evolution in technology, health care organizations are stressed trying to stay on top of the constant progression. HIT services firms provide flexibility, efficiency, and effectiveness, particularly in the ambulatory environment. They allow you to choose the services you need to complement, supplement, or supplant what your organization's IT staff does. The concentrated focus that an experienced and expert IT solution provider can bring to the table can help HIT organizations meet the technology and business challenges in ambulatory care, provide superior support to providers, and contribute to a higher quality of patient care.

— David Christianson is senior vice president for Versatile Healthcare Solutions.