Congressman Phil Gingrey, MD, opened the Physicians’ IT Symposium on Sunday at the Healthcare Information Management Systems Society (HIMSS) annual meeting in San Diego by providing a strategic framework to guide the American health information technology community. Tort reform, reimbursement and pay for performance all drive healthcare IT at the federal level, said Gingrey. Widespread adoption of IT improves patient care and cuts costs; Gingrey cited calculations estimating that widespread adoption of health IT of could save $163 billion annually on healthcare costs.
The EMR: Assessing Readiness, Realizing Benefits and Overcoming Barriers
Arnold Wagner, MD, medical director of clinical informatics at Evanston Northwestern Health System (Evanston, Ill.), covered readiness assessment for EMR (electronic medical record) adoption. Wagner defined the five levels of the EHR (electronic health record), beginning with automated medical records, which remain dependant on paper-based medical records but incorporates computer elements like ADT and dictation. The EMR is a middle stage based on an IT infrastructure for capturing, processing and storing information. The process culminates with the EHR, a comprehensive collection of patient-focused data that is available as a workflow engine to authorized caregivers across multiple provider enterprises and bridges the inpatient and outpatient world. Workflow capabilities include documentation, decision support and communication.
Advantages of the EHR are reduced malpractice rates, appropriate compensation and creation of a virtual medical group. Successful adoption requires four elements, said Wagner.
- All key leaders share the vision
- The organization commits to EMR success
- Personnel are thoroughly trained, and a capital plan is implemented
- Adoption is viewed as an opportunity to improve patient care and increase revenue
Wagner concluded with suggestions for overcoming impediments: healthcare enterprises on the EMR track should demonstrate operational success and economic benefits and market the project in the community.
Enterprise HIT Readiness Assessment
Michael Zaroukian, MD, PhD, chief medical information officer at Michigan State University in East Lansing, Mich.; Norman Gruber, president and CEO Salem Hospital in Salem, Ore., and Mark Del Becarro, clinical director, information services at Seattle Children’s Hospital in Washington, shared strategies for assessing and influencing organizational EMR and HIT readiness.
Readiness is critical to success and falls into three categories: organizational, individual and technical, said Zaroukian. Physicians and clinical staff should see health IT and the EMR as an essential tool to improve care and demonstrate a willingness to learn, work together, change work patterns and fully use the EMR. The leadership should support and champion HIT use and develop congruous IT and enterprise strategic plans. The IT team should demonstrate a track record of successful implementations and have necessary technology and training and support resources, and it should involve users in decision-making.
Gruber said organizations that focus solely on technology deployment often fail at implementation. Other dimensions of readiness are processes, people and knowledge. Salem Hospital completed a thorough readiness assessment including interviews and an automated survey to guide project planning and proactively identify challenges and technology-supported enhancements to improve processes.
Del Beccaro focused on clinical leadership. The three major factors in determining readiness are vision, will and execution, said Del Beccaro. Seattle Children’s used patient safety and standardized medicine—not IT—to develop and communicate its vision among clinical staff. The organization is ready when it views EMR/IT adoption as mandatory not voluntary, said Del Beccaro. Elements of execution include standardized processes, decision support, ease of use and added value vs. automation of the current state.
The combination of vision, will and execution paid off for Seattle Children’s. The hospital converted its inpatient, ER and OR to computerized physician order entry in 14 hours. More than 2,000 users open more than 10,000 charts and place more than 10,000 orders daily.
Choosing and Implementing an EMR for the Physician Practice
James R. Morrow, MD, vice president and CIO of North Fulton Family Medicine in Cumming, Ga., offered advice for EMR selection. Morrow whittled the steps in the EMR adoption to: make the decision, shop for the right vendors, complete site visits, define needs, analyze workflow and costs, form an implementation team and implement.
Success requires a physician desire to initiate change, an understanding of the need to control costs and a good implementation team including a specialist and a vendor/partner committed to service.
One of the most important steps in the process is the needs assessment. It begins with an assessment of current IT resources including existing interfaces, reporting tools, manual processes and organizational structure. Next, the assessment looks forward and analyzes the number of locations/connections, number and needs of users, anticipated growth and interfacing capabilities with labs, imaging centers and RHIOs (regional healthcare information organizations). The practice must consider database design, ASP (data stored with vendor) vs. client-server (data stored onsite) solutions, voice recognition, customization needs and processes and data sharing among users.
A successful implementation requires that the implementation team communicate costs and risks of the EMR, positive and negative impacts and goals and objectives to ensure cooperation and change management. Morrow recommended a mandatory simultaneous implementation.
The practice should create templates and an electronic “superbill.” Finally, successful implementations require staff training. The practice should develop a plan for converting from paper to paperless; North Fulton Family Medicine employed a piecemeal approach and completed the conversion by the third visit, selecting the most pertinent items for scanning.
Other decisions to be made prior to implementation are wiring, wireless devices, VPN (virtual private network), IT support and data backup. Morrow concluded with the benefits of EMR adoption: return on investment in real dollars and job satisfaction.
The Crystal Ball
Mark Leavitt, MD, PhD, chair of Certification Commission for healthcare Information Technology and several health IT leaders discussed national initiatives and industry trends to provide a snapshot of the future, answering the question: what are HIMSS themes next year, in 2010 and in 10 years?
The panel agreed that drivers will remain constant over the next year. Costs, access, privacy, declining reimbursement and reverse incentives will remain major factors.
In the next several years; however, the software gap will become more acute. The EHR drums will beat louder, and a strong theme of the 2010 HIMSS will be the need to develop a system for successful EHR adoption. Meeting topics will focus on how to make the EHR work, meet financial objectives and improve quality.
By 2015, the U.S. will finally have regional health care systems with standards and communications capabilities. Widespread connectivity will change the role of physicians.
Surprise Guest: Dr. Brailer
The Physicians’ IT Symposium ended with a surprise guest. National Health IT Coordinator David Brailer shared his thoughts of the current state of pay for performance and health IT and the interplay between the two. Brailer stressed that pay for performance is a step in right direction, but only a step. It does not align value in healthcare.
Brailer outlined four concepts to help foster a better understanding of HIT and pay for performance.
- The U.S. must recognize that in the absence of other policies, it needs pay for performance. Health IT can help measure items that constitute value.
- On the flip side, pay for performance needs HIT; practices with HIT in place perform 30 percent better on performance metrics.
- Unless the current direction changes, pay for performance and HIT favor large practices. There is an adoption gap that correlates with practice size. Pay for performance and HIT must be ubiquitous among large and small practices, said Brailer.
- Without a change in direction, pay for performance and HIT favor enterprise centric care. The country needs collaborative system processes to improve care and ensure accountability and financial alignment.