Healthcare IT News - March 2008 - (Page 9)

www.HealthcareITNews.com March 2008 ■ Healthcare IT News Former Senate Majority Leader William H. Frist, MD, a heart surgeon, was one of the keynote speakers last month at the Healthcare Information Management and Systems Society Annual Conference and Exhibition. Before the event Healthcare IT News asked him for his opinion on some key healthcare IT issues. What single healthcare information technology initiative would most influence the healthcare system as we know it today? the fundamental technical challenge is interoperability and that can be overcome with national standards, a unique national identifier for each person, standardized data elements with single terminology, and development of sustaining funding models. Paper kills. the push toward the paperless system at the level of the doctor-patient should be the focus. It opens the world to 21st century information that we know can transform medical care. Health policy academics doubt the power of a consumer-driven (“It’s just a trend”), patient-centered and provider friendly health care system. I don’t, because the transparency and accountability that ensues from the exchange of secure, privacy-protected health data at the patient/ consumer/provider level propels our health sector to become more value-based. medical errors, waste and inefficiencies will all be ripped out of the sector in very short order. costs go down and quality goes up. the public, the government, and those inside the health system now understand the powerful value of the electronic medical record, so I would keep it at the center of public discussion, o m m n t r y always meet the needs of clinicians in terms of comprehensiveness, ease of use, or speed. Physicians do not resist technology; they resist technology that doesn’t make their lives better (save time, money, or improve quality). the fundamental problem is that the clinician needs quick, reliable access to the information they need at the time and point of care. most of the benefits of health It go to society, to the health plan, to the payer, to the government. almost none go to the everyday practice of the doctor seeing and treating a patient. In fact, most health It as currently available and configured puts an additional burden on the individual doctor, his practice, and on the time he can spend with patients. Until we align the incentives of everyone – and I’d argue beginning with the doctor (who directs about 80 percent of all costs) – we will see only slow adoption of the tremendous technology we know exists. that means, I believe, pay the doctors more if they adopt certified It in their everyday practice. It’s not bribery of the doctor; it’s just that he or she is the one who is paying the price to accomplish all the benefits for society yet they personally are not receiving any of the benefit. a new alignment of financial incentives will take care of any alleged fear of technology or change in work process. Indeed with It, clinicians will change the way their offices and days are organized, how they enter and retrieve information, the process of how to make medical decisions, and the ways they interact with patients. n More at HealthcareITNews.com e Connect: frist 0308 Government’s role in healthcare IT should be limited though we all know it is really just the tip of the iceberg of the potential advances in It. What will a physician practice look like 10 years from now? Dad practiced internal medicine for about 50 years. as a little boy hanging around his office my job would be to run down to the basement to get the tattered folder stuffed with pages of semi-organized handwritten notes for a patient who hadn’t been seen in a year. things haven’t changed much – yet. But over the next 10 years, the office of every doctor will be radically changed. Gone will be the entire front office organization of clipboard, filling out the blanks for the hundredth time, struggling to recall what medicines you are on. Physicians will see less paperwork, and that will leave more time with patients, reversing the devastating trend of the past 10 years where physician offices have been deluged with paperwork and red tape. and it means more time with family. the administrative structure and associated costs will be greatly diminished. the virtual office made possible by electronic transmission of data means fewer office visits for patients and more home diagnosis and ongoing care. today’s bottleneck will have been relieved: for each patient the doctor will have the right information at the right time she needs it. Which means better care for the patient. and lower costs for all. Health It will be more than transformative; it will be revolutionary. It will take a bit of time for the culture of the physician office to adjust. I believe some financial incentives for physician adoption will greatly accelerate the process. What role, if any, should government play in encouraging the use of healthcare IT? Government does have a role, but only a limited one, a facilitating role. Health It will continue to be driven almost entirely by the private sector. that is where the creativity, energy, dynamism and innovation rest. I can tell you from intimate first hand experience of being at the top of the legislative branch in Dc that Washington moves too slowly, is too bureaucratic, and is too likely to encase the wrong answers in stone. my philosophy of the federal government’s appropriate role is laid out in a bill that I co-authored with Sen. Hillary clinton (FristWilliam Frist, MD clinton S.1262 - Health technology to enhance Quality act of 2005). this bill focused on establishing national interoperability standards, protection of patient privacy, grants to local or regional collaborations of hospitals, health plans, doctors, consumers and employers to develop health It infrastructure. It supported modifications to the medicare physician fee schedule to include provisions to encourage the adoption of health information technology standards and the reporting of quality information by physicians serving medicare beneficiaries. What is the greatest challenge physicians face in IT uptake? Money, fear of technology? Change in work process? Physicians fear that adoption of health It will lead to a fall in productivity (and thus income). the current generation does not ● Why not start with a national approach to linking data? By Tom F. SHuBNell, HIMSS Fellow at the 2005 HImSS conference, Dr. David Brailer restated the Bush administration’s commitment to building a healthcare It infrastructure. Brailer, then the national coordinator for health information technology, promoted regional health information organizations (rHIos) as building blocks to help move the nation towards interoperability. I think this is inherently flawed in its basic premise, because without a national framework of standards, regional building blocks can only develop a tower of Babel, not much better than what we have now. n his keynote speech I able electronic health information among providers within a defined region. current rHIo problems consist of lack of a long-term funding model, conflicting standards, technical issues and difficulty of persuading competitors to cooperate. If we have yet to solve the basic problems, are we doomed to repeat the fate of cHIns? PROvIdeRs Hospitals and IDns have not achieved 20 percent adoption of electronic medical records, with the largest reasons for lack of adoption being high cost, lack of interoperability and the amount of effort required to implement. Implementing an emr is not a typical project with a beginning, middle and What Is a RhIO? end. It is a continuous process, which once begun there are many definitions for rHIo, and we have will never end, so too with a rHIo. yet to come to consensus on a single definition. In fact, the office of the national coordinator for Thomas F. Shubnell Sixty percent of physicians, the second largest Health Information technology at HHS is paying consul- contributors of patient record information, work in practants almost a half million dollars to help come up with tices with one or two doctors. the vast majority of all physiconsensus definitions for rHIo and other terms. cians do not have electronic medical records systems, and those that do use record systems from literally hundreds of If we cannot define it, how can we implement it? small local vendors. If we have yet to adopt electronic prescribing (the simplest of all healthcare transactions), can RhIOs aRe sImIlaR tO ChINs rHIos are similar to the community health information we really implement rHIos in the near term? the $29 networks (cHIns) concept popular in the 1990s. the prem- billion that could be saved by electronic prescribing would ise of rHIos and cHInS is that sharing patient informa- go a long way toward paying for rHIos. tion for the greater good of the patient and community is appropriate and cost effective. cHIns failed for many staNdaRds reasons, including financing, governance, conflicting stan- a key problem to be solved in order for interoperability to dards, technical issues and the difficulty of persuading com- become a reality is the single patient identifier. although petitors to cooperate. the rHIo concept involves estab- this was also a HIPaa goal, the creation of unique health lishing a nongovernmental entity to oversee the business identifier for every individual has never been accomplished. and legal issues involved with the exchange of interoper- Indeed, the issue is being avoided by both the public and private sectors. If we cannot uniquely identify the patient, how can we develop an emr or a rHIo and be confident the supporting data is correct? another major problem is that there is no standard among institutions for the paper medical record content. even individual institutions with standard formats have content that is as individual as the contributor of the data. Well known and common standards, such as IcD9, http://www.HealthcareITNews.com http://HealthcareITNews.com http://www.healthcareitnews.com/story.cms?id=8864 http://HealthcareITNews.com http://www.healthcareitnews.com/story.cms?id=8865

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Healthcare IT News - March 2008 Contents No. 1 E-prescribing ‘Quite Bright’ Bill Frist on IT Google Connection Poised for P4P ‘Smashing Success’ Tough On Fraud It's Analytics Getting Rid of the Pain Stuck In Neutral

Healthcare IT News - March 2008

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