Slowing Down EHR Implementation

Great article on why medical organizations should slow down on adoption of EHRs (http://histalk2.com/2010/02/15/readers-write-21510/) -- issues with EHR design, impact on patient care, and concerns about whether the government will be able to fulfill its obligations under HITECH.


As an HIT consultant, I see another big reason to go slow with EMR adoption: many organizations rushing into electronic health records without recognizing the ways the software will impact their current operations and processes. After years of doing things a certain way, front and back offices are faced with the need to change how they bill, how they track patients, how they complete forms, etc. The failure to do adequate business process work on the front end often obviates any gain the electronic systems could bring, at least for the first year of implementation. And that’s the year that you have to perfect meaningful use.

Personal Care as Health Care Reform

As Micah shared in a previous post, we went to the World Health Innovations and Technology Congress (WHIT5.0) in Washington, D.C. last week.  It was an awesome experience, and Micah gave a great overview of the conference.

I walked away with several clear impressions:  one of them is that before we can make significant progress on health care reform, we need to engage patients (notice I'm talking about health care reform, not reform of the ridiculous financial system that surrounds it).  In fact, both Bill Clinton and Newt Gingrich agreed on this point, and you can't get much farther apart than that on the political spectrum.  Many other speakers and panelists at the conference said the same thing.

Why patient engagement?  Because patient engagement in their own care will encourage lifestyle changes -- changes like losing weight, stopping smoking, exercising, managing diabetes more carefully.  And these changes would result in big reductions in major illnesses:  type II diabetes, stroke, heart conditions, and many cancers.  In turn, besides increasing quality of life for millions of Americans, billions could be saved on treatment of these diseases -- diseases which are extremely high cost in both length and type of care.

Billions of dollars saved, which can be used to pay for health care for the un- and under-insured; to finance rural clinics; to reduce insurance premiums; to improve care of non-lifestyle-related illness.  Okay, this is a little pie-in-the-sky, because some of that money will end up in the pockets of insurance companies; but the possibilities of freeing up that kind of money are pretty exciting.

What's next?  Well, lots of companies are working on various platforms that will allow patients to be involved in their care.  They range from Web applications that integrate directly with the patient's EHR (like Palo Alto Medical Foundation's PAMFOnline built on Epic's foundation) to Keas' care plans and self-monitoring tools to Google Health's online records.  All show promise in different ways, but my bet is on provider or payor driven (or funded) systems, because they have the most to gain by using these systems.  Vendors like Keas will be successful only if they can pull in corporate users and figure out a way to be transparent to physicians.  But there are definitely some changes going on in this space, and they bode well for health care reform and financing.

Guest Blog: WHIT 5.0

Written by my good friend (and boss), Micah Dylan:

WHIT 5.0

 

Members of the VelocIT executive team participated in the World Healthcare IT Congress in Alexandria, VA this month. Bruce Fielding and Micah Dylan attended, and we sponsored Dave Burrill, from Wisdom Legacy, and Joyce Hunter, an executive consultant from Washington, DC, as co-attendees.

 

A few highlights from the show:

• Bill Clinton spoke on the need to increase healthcare capacity in developing countries, but in the US we have to focus on removing rigidity from our healthcare system. It has become ossified due to a lack of standards that have locked easy flexibility and capability away from patients.
• Newt Gingrich spoke about the problem of personal accountability and the type of programs and incentives that address individual, cultural, and organizational issues before financial ones. His new foundation, the Center for Health Transformation, is focused on these issues.
• Dr. Donald Simborg from Health Level Seven (HL7) became our new hero when he said that "it's more important to agree on a standard than to find the perfect standard. The most value comes from simply having a standard and moving on. The Internet developed because we had TCP/IP, not because that was the best networking standard you could possibly have."
• The 'last mile' problem from a local Health Information Exchange (HIE) to providers is probably the biggest technical hurdle. That encompasses standards, implementations, and adoption issues which may be insurmountable.
• The move to a National HIE (NHIE) is extremely far off and 'unlikely in our lifetimes' according to some. The last mile problem looks more like the last light year.
• Others are focused on orthogonal problems, such as leveraging the skills of healthcare experts to provide personalized healthare to the many rather than the few. One good example is Keas.com, by a former Google VP.
• Within existing systems, value needs to be increased by focusing on usability and better return on value to payers and providers through automation and business process improvements.
• There has to be a focus on involving patients in their own care.  Several speakers noted that the largest savings in health care costs will stem from preventing conditions like diabetes, heart disease, and life-style related cancers.

-- Micah Dylan