SIIM Keynote: Navigating the changing landscape of health IT implementation
The first thing that John P. Glaser, PhD, vice president and chief information office at Boston’s Partner Healthcare System made clear to the opening general session of SIIM 2007 in Providence, R.I. today, is that he is not overtly skilled with technology. Not that anyone believed him. Glaser shared that he does not carry with him a PDA, or a cell phone, and the biggest reason he does not is because no one ever uses these tools to tell you anything pleasant. “I’m trying to live a stress free existence and you’re screwing it up,” he joked.

However, his incredible grasp of what it takes to successfully implement health IT is no joke, and he should know because Partners is a top-tier implementer. Beyond how to make it work today, he also has a pretty good idea of where it will take us a few years down the road.

Currently, Glaser said, over two-thirds of hospitals have a full or partial EHR in place, with a breakdown of 11 percent that are fully implemented; 57 percent that are partially implemented; and 32 percent that have no EHR at all. According to 2006 American Hospital Association numbers, overall the level of health IT being implemented is on the rise. “There’s an appreciable level of growth,” he said.

But the growth is not universal, and in the case of small physician practices (1-2 doctors), there is barely any growth at all. The biggest areas of improvement are in larger facilities with multiple stakeholder practices.

So, the idea of universal adoption might not be a reality, maybe it never will. But for those facilities that do bring on health IT there are strategic ways to gauge and assure better success.

The biggest way to do this is to exercise “continuous improvement of processes.” Some facilities, he said, go all out and implement health IT to the full extent currently possible and still cannot determine if they’ve gained any benefits. Again, he joked, “having a chainsaw in your attic doesn’t mean the trees come down automatically.”  Hospitals have to work at it. Health IT is best used as a tool and processes must continually be evaluated and improved.

And changes to processes should be incremental, not “big bangs,” because strategic value is the result of a cumulative effect from diligent sustained improvement efforts, Glaser said.

However, he warned attendees that “the presence of an application will not distinguish you” in comparison to your competitors. What will distinguish you is your use of the tools and the processes that you have in place.

There are several specific ways that Partners has been able to reap more from its health IT investments. One is by leveraging whatever data is on hand. This could be used towards care and operations process improvements; development of pay-for-performance contracts; comparisons of product or medication outcomes; or developing feedback loops with users regarding applications to development workflow improvements.

Another way of wringing out more value from your investments is by “extending the reach of the clinical systems to patients,” he said. Examples of this are personal health records or patient-provider portals. Ubiquitous ATM systems are a good example of how certain healthcare-related technologies could be common everyday technology at some point in the future, Glaser said.

Another example of extending reach is systems integrations with other healthcare institutions. This can be done via clinical data exchange, extending clinical systems into affiliated organizations, or a myriad other ways as long as it serves your needs.

Broader efforts to network regionally or nationally through RHIOs [Regional Health Information Organizations] are facing “real problems,” he said, in the form of “a classic implosion.” Data show that 70 to 80 percent of RHIOs are expected to fail in the coming years. The reasons are many. Overall, he said, it’s hard to get competitors to cooperate, and there are problems with data security, and financing is hard to come by.

Yet, the seeming failure of RHIOs is now spawning a child: RHIO 2.0. This new iteration has its sights set a bit lower. RHIO 2.0 brings much more targeted efforts by specific organizations undertaking integrations for certain business goals, rather than the broad integrations that have been going on. Some examples: integrated health delivery systems, payer/employer PHRs, state efforts to undertake healthcare system integration, and others.

Also on the horizon, Glaser believes, will be larger organizations having difficulty adopting broadly implemented common applications across enterprises. He believes that individual clinical system “pieces will not go away”, but rather will be incased within common service oriented architecture. Within the architecture certain things will be implemented as targeted commonalities, for instance having a common patient identification method between all systems.