Healthcare Musings - January 2011

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It’s 2011 … What’s Next for Health IT?

By H. Stephen Lieber

H. Stephen LieberJanuary, 2011 - What’s ahead for healthcare information technology and management systems in 2011 … and beyond … depends not only on adoption of meaningful use, but also on the ability to see beyond the deadlines and move forward to ensure quality and consistent patient care with this technology in place.

Some healthcare organizations already deliver quality patient care with an electronic health record (EHR), and research from HIMSS Analytics indicates that just 52 U.S., non-governmental hospitals - 1 percent (as of December 2010) - operate in a completely paperless environment.

But more relevant research from HIMSS Analytics looks at hospitals’ readiness to meet meaningful use, with 24 questions added to its annual hospital survey. These questions are based on the final rules, which designate a “core” group of 14 requirements that a hospital must meet to achieve Stage 1. There are also 10 “menu” items, from which providers must meet five of their choosing to achieve Stage 1.

Preliminary data from HIMSS Analytics from 687 U.S. hospitals released in November 2010 revealed that 19.5 percent of those 687 U.S. hospitals currently have the ability to meet 10 or more core items and at least five of the menu requirements items for Stage 1. This means that they’ve met the menu requirements and are close to achieving the core requirements, putting them on solid footing to achieve Stage 1 of meaningful use. Another 34 percent currently have the capability to meet 5 to 9 core items, suggesting that they are well along the path to meeting Stage 1.

The Value of the Electronic Medical Record

Some hospitals and medical practices have already implemented the electronic health record and recognize the value and benefits of an interoperable and digital exchange of patient health information. For example, testimonials from HIMSS Davies Awards of Excellence winners - which are healthcare organizations with health IT in place that report value from using this technology—as well as Stage 7 hospitals, tout the benefits of health IT and management systems. These include more time for patient care, fewer medication and medical errors, immediate access to patient records from home or office, and savings on various levels from transcription to space for medical records.

The President’s Council of Advisors on Science and Technology detailed the benefits of health IT in its December 2010 report to the President, “Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward,” stating in the Executive Summary (p. 1) that “Information technology (IT) has the potential to transform healthcare as it has transformed many parts of our economy and society in recent decades.”

The report details specific benefits when health IT is properly implemented. These include: access to complete data by clinicians; ability for patients to become more involved in their own care; improved clinical trials and advancement toward personalized medicine; improved workflow; creation of new jobs and markets; and support of economic reforms in the healthcare system.

Such evidence and promise should hasten, rather than delay, adoption of health IT. In fact, meaningful use has become the catalyst, a powerful protagonist for action with the nation moving closer in these next four years to an interoperable electronic health record system.

Challenges of Meeting Meaningful Use

Still, hospitals and health systems, and physicians, face different challenges in meeting meaningful use - factors that will determine exactly how the healthcare turn-of-events in 2011 and beyond will play out.

Hospitals: Hospitals must prepare (and pass) site certification for self-developed systems, modules and workflow, a situation that perhaps six months ago most hospital executives believed vendors would be managing. In addition, these healthcare organizations must integrate mobile platforms into existing enterprise systems and manage huge amounts of data with business intelligence strategies in place to make use of the influx of digital data. In addition, the ICD-10 transition coincides with meeting meaningful use deadlines, giving healthcare managers another deadline to meet.

Hospitals also face the challenge of transmitting data directly from the EHR to report meaningful use, instead of sending it from a data warehouse. They also must align multiple data capture and performance improvement initiatives for reporting.

Ambulatory practices: The National Ambulatory Medical Care Survey (NAMCS), conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS), collects information on the adoption and use of electronic medical records/electronic health records. The report, Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States 2009 and Preliminary 2010 State Estimates, indicates that almost 51 percent (50.7) of physicians reported using all or partial EMR/EHR systems in 2010.

Many of the challenges in meeting meaningful use that a practice must overcome are out of the direct control of the practice itself, such as the external infrastructure challenges of bi-directional digital prescribing, data capture and reporting, and immunization registry reporting.

Consistent gaps include:

  • Functionality to capture race and ethnicity.
  • Ability to meet the 40 percent requirement for e-prescribing.
  • Ability to provide patients an electronic copy of their health information (diagnostic test results, problem lists, medications, allergies) upon request.
  • Ability to provide electronic discharge instructions to patients upon their request.

As a result, ambulatory practices face specific challenges based on many factors from practice size to workflow and income stability. Barriers to adoption include EHR funding for small practices; understanding the role of Regional Extension Centers; securing a trained workforce to meet the meaningful use EHR reporting criteria; maintaining positive account receivables; and depending on the stage of adoption, managing an EHR implementation project.

Conclusion

Time will help determine how healthcare organizations and providers overcome the obstacles they face in implementing health IT and management systems and meeting the demands of meaningful use. The HIMSS Meaningful Use OneSource provides an online compendium of vetted resources on meaningful use. It covers The Basics: Meaningful Use 101; Qualifying for Meaningful Use and Funding; and Putting MU into Practice with more than 400 documents anyone can access at no charge. Information on this online resource and the 2011 Annual HIMSS Conference & Exhibition, scheduled for Feb. 20-24, 2011, in Orlando, Fla., can be found at www.himss.org, the HIMSS website. 

About the Author

H. Stephen Lieber, CAE, is President and CEO of HIMSS, a cause-based, not-for-profit focused on the optimal use of information technology and management systems for the betterment of healthcare. HIMSS represents approximately 30,000 individual members, more than 470 corporate members and more than 80 not-for-profit organizations that share its mission.

Since becoming President and CEO in 2000, Lieber has established the Society as a global leader on issues such as electronic health records, interoperability, technology standards, IT adoption and certification. He has also brought significant growth to HIMSS, more than quadrupling the organization’s size and expanding its scope to encompass ambulatory IT issues and healthcare financial information systems, in addition to HIMSS leadership in the acute care clinical information systems arena.

Lieber holds an M.A. from the School of Social Service Administration at the University of Chicago and a B.A. in Psychology from the University of Arkansas. He has completed additional course work at the graduate schools of business at both universities and at the Keller Graduate School of Management. Lieber brings to HIMSS more than 30 years of experience and leadership in healthcare and healthcare association management, for which he has been nationally recognized as one of the Top 100 most influential people in U.S. healthcare from 2004-2010.

Contact H. Stephen Lieber at slieber@himss.org or 312-915-9268.

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