Health IT Adoption
Introducing change in health care is never easy. Historically, adopting our most fundamental medical technologies, from the stethoscope to the x-ray, were met with significant doubt and opposition. So it comes as no surprise that in the face of change as transformational as the adoption of health IT – even though it carries the promise of vastly improving the nation’s health care – some hospitals and providers push back. I resisted using EHRs while an internist in Boston, as I wrote in my blog, “Why Be a Meaningful User.” Over time, however, I found that working with health IT made me a better and safer physician. Most importantly, my patients received better, safer care and improved outcomes.
There are thousands of stories like mine across the nation. The question health care providers are facing today is whether we are pushing too hard, too fast to make this important change. I respectfully submit, no. In turn, I ask, “Can we make these changes expeditiously enough?”
Americans deserve better health care than they are currently receiving, and they need it delivered more efficiently. Every provider, every patient throughout our nation will benefit from the goals envisioned by the HITECH Act. Yes, this will be a challenge. While large hospital networks and smaller providers may be stretched to meet national health IT goals, it is not beyond their capacity for growth.
Doctors and hospitals will not have to go it alone. Programs, such as our 60 Regional Extension Centers located throughout the United States, are working hard to ensure that providers have all the necessary resources to meet the challenge. The incentive program will then provide reimbursement to providers who have achieved meaningful use.
This is the time to realize the promise of health IT. Information technology has improved every aspect of our lives, we need to channel information technology to improve our health and care. Providing patients with improved quality and safety, more efficient care and better outcomes is paramount. Physicians who adhere to the oath of Hippocrates believe we must act with all deliberate haste. More than two thousand years later, we can’t forestall health care quality improvements, not when so many patients entrust their providers for the best care they can possibly deliver. As the saying goes, “If not now, when?”
I welcome your comments, and ask you to share your stories on how health IT has changed your practice.
One of the key factors to facilitating physician adoption of EMR systems is the approach that the organization takes to improve knowledge levels. Thinking “outside of the box” in terms of how you structure and deploy your training is key to long-term system optimization.
If done well and in a way that addresses diverse learning styles and needs, effective change management and knowledge improvement go a long way to successful implementations and system optimization.
Will we know what Meaningful Use means sometime this month?
I contend that “meaningful use” of HIT boils down to using electronic data for the continual increase of healthcare value – higher quality/effectiveness/safety and lower cost – to the consumer (patient). This includes using affordable HIT that helps clinicians and consumers avoid and manage health problems (acute and chronic, physical and psychological) by, for example, providing:
(a) evidence-based decision support including guidelines/protocols/pathways fostering cost-effective treatment and prevention);
(b) low-cost, convenient means for effective collaboration’ e.g., in support of patient-centered medical homes and practitioner-researcher networks;
(c) public health and post-market drug & device surveillance via HIEs; and
(d) clinical outcomes data by which clinicians are rewarded for delivering high value care, and by which patients are rewarded for managing their health by staying well and attending to chronic conditions.
Unfortunately, HIT is far from accomplishing these MU imperatives for many reasons (including the issues presented by Mr. Monatesti). But through radical innovation, supported by a more rational economic compensation model, HIT has great potential to evolve into tools that promote such truly meaningful use. The result would be lower healthcare expenditures and a healthier population; waste, errors, ineffectiveness, fraud, disregard and cost would be minimized as the consumer receives more cost-effective care and providers (clinicians, hospitals wellness practitioners, etc.) are compensated for delivering such high value care.
I work for a non-certified EMR vendor who has spent 2+ years trying to get Labcorp/Quest to the table to discuss interfacing. Unfortunately they find our niche market of geriatric specialists too small. Will these types of barriers be eliminated in time for innovative solutions to survive the exodus of customers jumping ship for a “certified” product?
If not now when ? That is the I question I asked regarding dentists as health providers been welcome to join the health information technology transformation of our nation healthcare system .
Issues for discussion, please provide your point of view, and possible resolution:
1. The HIT world has not addressed limits of liability, nor adopted a hold harmless clause
2. There is very little documentation produced, demonstrating that HIT enhances efficacy of procedures or medications
3. There is very little evidence that suggests that HIT enables continuous quality improvement or return on investment
4. There is a concern that HIE vulnerability, given the potential of cyber threat and the threat associated with single point of failure designs, could lead to adverse events and patient risk
5. There is the potential for unintendended consequence, such as, key stroke errors, read or interpretation errors leading to adverse events
Who is responsible and accountable? Who is addressing these issues? Are we moving forward on faith?
To expand upon the comments of Tony Onorand, a very efficient learning method that leads to high levels of knowledge, confidence and proficiency in the use of an EMR employs job and task specific computer simulators. It particularly facilitates physician adoption through the ability to learn 24/7 via a broadband connection, thus not taking time from patient care activities required by classroom and train-trainer training.
A crucial factor in physician adoption is physician engagement. In addition to input into vendor selection, a physician advisory group is very important. It should be a formally chartered group that is empowered by organizational leadership to establish and monitor written policies and procedures governing physician use of the EMR.
I agree. If not now, when?
Health Information Technology can not only provide better care, but will also let patients receive that care much faster than they do now as a lot of time is saved.
Interesting blog by David. Problem is he may never have worked in a small hospital (less than 20 beds). It is a whole lot different than working in a big hospital like in Boston. The government cannot make IT people live and work in small towns for small hospitals.
http://www.fierceemr.com/story/practices-will-lose-value-if-they-dont-adopt-ehrs-says-hit-coordinator/2010-06-17#comment-848
I have an open challenge to Mr. Blumenthal to prove that he is not full of hot air.
This top-down method of pushing practices into adopting EMRs that don’t fit their profiles is absurd. The current set of large vendors leaves a lot to be desired. and the ONC should be taking a cue from those of us that have created our own small “electronic practices” working with small IT firms or using our own ingenuity. Of course that would be too much to ask of the govt.
While I honor the high brow tone of this discussion, I must interject a little gritty, real world experience.
HIT sounds good. Ideally, it could enable faster emergency response and information sharing all across the health field. However, 1. Since HIT hit the offices of my child’s pediatrician, I don’t think my doctors have done more than glance briefly at my child. They are very engrossed in their PC, though. Is the focus on HIT implementation reducing the quality of health care? and 2. We are placing all our health information in vulnerable technology. Power outages, malicious code, and terrorism are real threats to HIT.
I find HIT a bit scary. I respect your analogy, but stethoscope and the xray machine changes aren’t really on the same scale as HIT, are they? HIT is distancing the interaction between health care providers and patients by inserting an all-powerful, injury-prone computer laptop between them.
I believe the personalization of Healthcare Services (i, e, personalized medicine, personalized treatment, etc) , as well as the exponential growth in Internet usage globally, such as Twitter, Facebook, etc., will enabled a speedy adoption of HIT, sooner or later.
Also, efforts by organizations, such as IHE’s Connectathon will ensured, global EHR/EMR/PHR adoption. We need to start looking or thinking of Healthcare Networks, been designed like the “Global Financial Services Networks”, as we start the implementation of US NHIN.
Please See: http://www.personalizedhealthcare.blogspot.com or http://www.compuline21stcenturyhealthplan.blogspot.com, http://www.gkquoquoi.blogspot.com.
Gadema Quoquoi
President & CEO
COMPULINE INTERNATIONAL, INC.
Or said another way: Training is important.
Do you have some specific examples … or is what you wrote framed by your academic theory or your EHR’s head of marketing told you to write up?
Turn Off Words: facilitating, ‘outside the box’, optimization (x2), diverse, change management, knowledge improvement, implementations
I believe that instead of the government focusing on reforming the health care system as much as they are, they should instead focus on improving the quality of food, getting the disease causing chemicals out of the food, and getting America to exercise and lose weight. After all that, tackling the health care problem would be much easier.
The sharing of electronic records is PAINFULLY slow! Really, how difficult can it be? Major banks have been moving money around electronically for years – and for the most part with pretty good security! There’s an ATM on virtually every street, from large banks to small gas stations. How is it that the money transfer process can be so safe and secure, but other types of data can’t? I think it can.
Never a good analogy. The medical information is much more nuanced than bank data, or gas stations. A very tired argument!
I agree with some aspects of your blog. Dr’s should not keep records on 3×5 cards but a paper chart is also quickly becoming antiquated. the governments actions are always punitive towards physicians and the mandatory EMR will make many good physicians retire instead of investing 100k in a system.
I agree that EMR helps us practice more efficient and better medicine. I disagree on government intervention.
I think the USA and Uk health care are very similar. For example some time both focuses on the wrong thing. Here in the Uk the NHS is in a shambles. You have to wait months sometimes to see a specialist so if you are not private prepare to wait a few month.
Take the accident & emergency, you go there and not only have to pay for parking but having to wait about 3 to 4 hours to be seen to. The NHS needs to get their system sorted so patient can be soon to in a timely manor. People’s health are at risk if this is not sorted out.
As a former government CIO I can tell you that “There will always be a resistance to change” in the health care industry. However, as in all other sectors the adoption of the “Health IT” program is important for all patients. It can be sad, even as a Medical Instrument Sales guy, to check into a hospital where you have already “had a child” and have someone in ER sit there and ask you questions (that you already filled out prior to the final emergency visit) that you have answered many times in the past while your wife is in labor (just a random example).
Technology is an important aspect of checks and balances in all departments.
None of these things will change the fact that people are and will always be “resistant to change”…
You just need a great Change Management plan to make it happen!
As one who has successfully led HIT initiatives, including BPOC, Clinical Decision Support and the like, I fear we may be ignoring the revenge effects of this technology. Edward Tenner describes such phenomena in his book entitled “When Things Bite Back, Technology and the Revenge of Unintended Consequences.” I have been witness to the benefits of HIT at the sharp edge. I have also experienced many unwelcome surprises the lack of standards and significant lack of accountability at the vendor level have caused. Sharp-edge clinicians feel as though they are trapped and work-around is the order of the day. The same can be said for the back-office.
Are we diverting from the bedside to amass huge departments of IT professionals that troubleshoot server farms as well as work with IT vendors to fix “turnkey” software? Could these dollars be better spent? We are years if not decades away from realizing any real return on investment from HIT, if it comes to fruition. The complexity has been grossly underestimated.
I agree that technology can be extremely useful in diagnosing and treating illnesses so I am not against it. However, what I have noticed is that many doctors seem to be relying solely on what their computer tells them. As one of the other commentators here said they doctor didn’t really look at the patient. IMHO, the technology should be there to back-up or help confirm the doctors diagnosis following the examination of the patient, and also to assist in treating the patient if necessary. I think we are in danger of becoming dependent on technology and ignoring the human side of the doctor-patient relationship.
I am just curious if the IT adoption will translate in lower costs for US government or for the patient. I doubt. We all know the efforts big pharma do to control the brand medication market. Probably the same will happen with this also. Some big IT and hardware manufacturers will generate lots of revenue from such adoptions and the patient will be the one who will pay a higher bill anyways.
I agree with Jenna. Technology has its place but should not take the place of eye contact with your doctor. I was at my doctor’s recently and she had her back to me most of the time looking at her computer screen. As a patient I am feeling more and more like a number and/or statistic. But having said that… I do appreciate what technology can add to the medicine. We have to remember – technology is a tool and shouldn’t replace valuable interaction between the patient and doctor.
The technology can certainly provide better care and the fact that this will mean patients can actually get the care quicker is an even bigger benefit. I think it would work better in the larger hospitals in cities where the resources and manpower are more readily available.
Recall the Annals of IM article of a few years back. No increased performance when EMR used over Paper charts. Poor organization and discipline will exist no matter the platform.
The changes will never be implemented fast enough to cope with the strain on these services. Red tape and other issues always impede on progress.
Where are the rules allowing for clinical applicability of the system we establish and the cost containment? Patient oriented information technology rather than information technology for technology’s sake! With the 11% cut in medicare fees, lack of funding of electronic medical records for ALL physicians, 20-30 % medicare or medicaid, or not, inappropriate audits of physicians with the assertation you are guilty of fraud unless you documented the lack of the negative finding, why should any private physician or physician group be inclined to implement these systems? Especially as motivated independent physician groups who want to interface, previously unfunded, remain ignored, those already funded get more, and the common language and definitions remain lacking making the physician the default common denominator to make propriatery systems work, without paying for the trouble. Information exchange between big systems is not the point. exchange between providers of healthcare, healthcare professional to professional is the point! not hospital to hospital! It’s no longer worth while and until those in power start listening, we remain unlikely to succeed. Sincerely, a previously hopeful, now doubtful believer in t implementation of our information systems…please start paying attention and listen.
The provision of health care is a deeply personal service, which lends itself poorly to quantification or benchmarking. Too often, medical record keeping has been characterized as woefully behind banking, education, etc. ITS NOT THE SAME THING!! YEs, certain aspects of health care may be measurable, but not everything needs to be in a searchable field. NO, increased detail of recordkeeping DOES NOT NECESSARILY mean better care.
FEARS AND OBSERVATIONS:
SInce EHR adoption at my practice and at my hospital, records are harder to read in an efficient manner, information is NOT concise nor easily locatable, accuracy has fallen. rounds take twice as long, and my eyes hurt from staring at monitors.
New types of care errors are being seen (carryovers, one-off-the-mark click errors, etc)
PAtient complaints of impersonal nursing has increased “always on the computer”.
Physician Staff Morale is now at an all-time low, since EHR adoption.
I have a new full time employee to handle EHR nonsense errors, “upgrades”, and have realized no personnell savings as promised
I have been thru 3 iterations of my EHR in 8 years, without even changing vendors. My 2002 records are getting more and more buggy. What happens in 20 years? HAS ANYONE THOUGHT ABOUT THIS?
EHR seems great if starting a new office, but perhaps we should consider grandfathering existing offices, to some degree, rather that threatening us with eventual penalties if we don’t get on board ASAP.
Recently a woman asked me go to the doctor’s office with her. She told me her doctor, turned his back to her and typed on his computer and the doctor would get upset at her for not answering his questions. She has a slight hearing loss, just enough that with his back turned to her she couldn’t hear him, clearly.
I went with her and relayed EVERY ONE of his questions to her…
The doctor offered me the job, of relaying questions to his patients, with pay and both the woman and the doctor, thanked me.
I do not think this is funny, I do think the woman needs to find a real doctor, I do not recommend that doctor, and I refused the ‘job’ offer.
Increasing the IT in health care to make it more efficient all around is a great idea. When it comes to technology and health care the proper security standards must also be taken into consideration. Like banking security standards.
Are the security issues being taken into serious consideration with the developments in health care IT? I would imagine they are with the amount of resources.
I agree with a previous comment regarding food quality in the U.S. I think we should enforce more safety regulations on food. For example – we have done a good job on “transfat”, which is no-longer in most foods. Their are many more toxic chemicals added to our everyday food, however if they can continue to research and find these toxic foods, they can continue to ban them as well.
Venessa
Consumers and employers need better transparency to manage health care costs and improve medical treatment. Wellness grants in 2011 will promote healthier lifestyles and cause consumers to go online to monitor their health. One wellness provider is using doctors for health coaching telephonically. Even though some conditions require face to face visits with your doctor, the move toward more efficiency will make it easier for consumers to call their doctor on simple issues who will have their records online.
I have been in the health care business since 1980. The impact of IT is huge. It’s an always-changing and with national health care reform, providers, consumers and local govt. agencies need to adapt. I think they will and within a few years, you’ll see a marked increase in efficiency.