Healthcare IT News - September 2007 - (Page 13)

www.HealthcareITNews.com September 2007 n Healthcare it News 13 By Janet M. MarchiBroda, CEO, eHealth Initiative o M M N T r y Data exchange requires ‘social capital,’ and more T this month will release its Fourth Annual Survey of Health Information Exchange at the State, Regional and Local Levels. What will the results tell us? That a handful of initiatives haven’t made it over the last year, and that several new ones have formed. They will also tell us that it’s taken a lot of time for these efforts to move from planning to implementation, and one of the primary reasons – as also noted in our 2006 survey results – is because it is so difficult to achieve a sustainable business model. What makes it so hard for leaders within their communities to build support for the mobilization of information electronically to support improvements in health and healthcare? For starters, our current reimbursement system largely encourages both volume and fragmentation in care – rewarding those who do more, but in many cases, not those who do better. As a result, there are actually disincentives for clinicians, hospitals and other providers, labs, and payers to share information. Those that have been successful in engaging local leaders in the implementation of health information exchange have done so because they have built “social capital” or a radius of trust that enables divergent interests to come together for a common cause to improve health and healthcare – despite market pressures to do otherwise. Building trust is founhe ehealth InItIatIve dational to information sharing efforts. Social capital is not sufficient, however, for success in health information exchange. Good business acumen, and the ability to understand, and convert the value that health information exchange provides to each stakeholder or “customer” is also necessary. What can be done to overcome some of these barriers? Leadership and consensus among multiple stakeholders on common principles and policies for information sharing and the creation and dissemination of tools and guides that can help local leaders build social capital and solid business models, are necessary to support the creation of a “network of networks” to improve the quality, safety and efficiency of healthcare. Given the need for social capital, as well as the fact that much of the data needed for care delivery actually resides at the local level – within hospitals, labs, physician offices, and pharmacies – the Nationwide Health Information Network really does need to be built from the ground up… but also is linked to networks already existing at the national level. There are many national actors in healthcare, including national health plans, national labs, national (and global) employers, hospital chains that operate nationally, and even the federal government – including Medicare, the Department of Defense and the Department of Veterans Affairs. And these national players are trying to figure out how to deal with the multitude of local efforts. The natural tension between national and local efforts is not new, and one which has been experienced in nearly every sector of the economy. standards we’ll apply nationally. We need to arm our state and local leaders with the tools and resources to get the job done locally, including those related to building social capital and building a sustainable model, and we need to support them by doing a better job at dissemi“ We need to figure out nating what we know today and how to build a bridge between also tackling new problems with practical approaches that work national and local efforts in the real world. through common interfaces And finally, America’s nationand policies.” al actors need to apply their – Janet Marchibroda resources and energy to collaboratively developing technical Getting to an improved system that informs guides and policies that help us link nationcare delivery and improves the health of the al efforts with local efforts, and we need to American population requires both, and widely disseminate them and provide “busiwe need to figure out how to build a bridge ness” incentives – to drive their adoption. between national and local efforts through It’s an important time in healthcare. We’re common interfaces and policies. getting closer to our goal, but social capital, So where do we go from here? First, we collaboration, good business smarts, and need leadership. We need representatives most of all – leadership – are required, now of every sector in healthcare – including more than ever, for us to take those necesclinicians, consumers, employers, health sary steps to drive a higher quality, safer, plans, healthcare IT suppliers, hospitals, more effective healthcare system for all labs, manufacturers, pharmacies, public Americans. n health agencies, and state and local efforts More at healthcareitnews.com to work together – hand in hand with federal ●connect: MarCHIBroDa 0907 e and state government, to develop common principles and policies about how we’ll get Janet Marchibroda is the chief executive officer this done. We should leverage the consider- of the ehealth initiative and its Foundation, both able leadership demonstrated by the federal Washington, d.c.-based independent, national nongovernment in achieving consensus on what profit organizations. Managing e-mail as component of electronic record By deBorah Kohn, HIMSS Fellow adding a public, nontranslatable e-mail address from compuServe to my business cards was pretty exotic, even pretentious. But conforming to the 90s e-mail etiquette list was pretty scary – with some Internet police officer lashing at me every time I “shouted” or mentioned my company name in the text. However, during that period, a tipping point occurred when one day I realized that my job had been transformed – forever. I no longer keyed letters on office stationary, wrote office memos, or, first thing every morning, grabbed the telephone to check my voice-mail box. even my relationships to friends and family became irrevocably altered! From that moment forward, my life became sending, receiving, and replying to e-mail. From that moment forward, what was then the electronic equivalent of the “post-it note” – the telegraph of the Internet – became the central communications medium for the interchange of all my business transactions and personal interactions. Not necessarily improved, but changed. even healthcare has been transformed. Although today I can e-mail everyone and everything except my physician, email continues to be used for an increasing number of traditional and non-traditional clinical, financial, and administrative activities that are essential for healthcare’s business processes: n Sending secured, digital reference lab results to the unit n Attaching secured, digital discharge summaries to the physician’s office n collaborating on the patient’s status n referring and transferring patients n Answering physician office inquiries n exchanging invoices, statements, payment information n Negotiating contracts urIng the early to mId-90s, responding to regulators So, when and what will be the next tipping point? Will e-mail become the secured, central communications medium for the interchange of all patient record transactions, including the electronic health record? I’m not a predictor of weather or technologies. However, as a certified health information management and health information technology professional, I can predict with certainty that healthcare e-mail records, especially patientrelated e-mail records, will be subpoenaed. consider the following facts: n Today, e-mail is the de facto business communication system standard in the world. n Today, e-mail is one of an organization’s largest and most vital information assets, with no end in sight. n In addition to becoming a communication system, e-mail has become a record-keeping system, not only because it is essential for today’s business processes, but because it reflects the business objectives of every organization (e.g., getting paid for services rendered). n Legally, e-mail is considered a “business record”, and, like all business records, it is subject to evidentiary disclosure and discovery. consequently, if the information or data contained within e-mail records are about the patient, e-mail records must be considered as one component of the eHr, just as electronic patient progress notes, orders, medication administration records, diagnostic images, and problem lists are considered other components of the eHr. consequently, “e-mail management” – a term barely used before the early 2000s, if then – must be included in the planning, implementation, and maintenance of the eHr. e-mail management does not refer to healthcare IT pron fessionals limiting e-mail box megabytes or acquiring more e-mail servers every year. e-mail management refers to applying the same thought and attention to the eHr that have gone to managing other byproducts of other digital communications systems, record-generating functions, and business processes. For example, it refers to a healthcare organization’s legal, risk, provider, HIM, and HIT professionals creating and maintaining patient email record retention and disposition schedules based on administrative, legal, fiscal, and historical requirements; establishing documented procedures for the scheduled destruction of obsolete patient e-mail records and retaining proof of such destruction; developing and implementing efficient eHr-based patient e-mail filing systems; training personnel in the use and function of established patient e-mail records management procedures; maintaining the confidentiality, security and integrity of the information in patient e-mail records; and, monitoring the completeness of the patient e-mail records. eHr-based e-mail management is an enormous and complex challenge, expected to get more serious as the number and type of senders and receivers increase exponentiall http://www.HealthcareITNews.com http://www.HealthcareITNews.com http://www.healthcareitnews.com/story.cms?id=7669 http://www.HealthcareITNews.com http://www.healthcareitnews.com/story.cms?id=7670

Table of Contents Feed for the Digital Edition of Healthcare IT News - September 2007

Contents Alaska Sweep SiCKO Debate Data Exchange Rx EDITH knows Hold That Script IT in the Sun Breathing Easy IT on the Menu Ambulatory EMRs Identity Crisis

Healthcare IT News - September 2007

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