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HIT: Enabling Quality
in an Evolving U.S. Healthcare System (pdf)
 
Submitted By:
Shannah Koss
Vice President
Avalere Health LLC
Erica Eisenhart
Manager
Avalere Health LLC
Abstract:
HIT will be a cornerstone of creating a rapid-learning healthcare system
that supports continuous quality improvement. However, to date, efforts
to improve quality and implement HIT and electronic information exchange
represent pockets of innovation rather than an interconnected system.
This paper examines HIT’s interplay with five components of quality
care – prevention and wellness, care coordination, patient safety,
transparency, and paying for value – and identifies near- and long-term
steps needed to achieve a healthcare system that uses HIT to enable high-quality,
efficient care.
EHR - A Step to Quality Care (pdf)
Submitted By:
Mark Roman
Vice President
Healthcare Industry, EDS
John H. Varga, MD, MHSA, FACS, CPE, CPHIMS, PMP
Abstract:
EDS and the Mayo Clinic discuss issues related to implementing EHRs
to improve care quality and lower cost, with a focus on the role of data.
We briefly discuss the nature of quality, the types of metrics under consideration
and the issues involved in determining the right set. We examine methods
and technologies for extracting and retrieving data in a format that can
be used to compute EHR performance metrics. And we offer steps organizations
can take today as EHR development advances.
Observations from the Field (pdf)
Submitted By:
Dale Emerson
Vice President and Chief Operating Officer
Transformations Consulting Group
Patti Dodgen
President and Chief Executive Officer
Transformations Consulting Group
Abstract:
After eighteen months of work with states and regional health information
organizations across the country, we want to share our observations on
the progress of and challenges facing HIE as well as the areas where additional
help is needed to move HIE forward. Based upon our field experience, we
have identified six challenges that are causing organizational and operational
problems for HIE efforts and five areas where additional help is needed
in the field to move HIE to the next level.
Crossing the Electronic Chasm: Developing a Roadmap For Electronic Health Records that are Operable as Well as Interoperable (pdf)
Submitted By:
Stephen R. Levinson, M.D.
Manager
ASA, LLC
Abstract:
Despite existing efforts concentrating on features that emphasize data storage and retrieval benefits of EHRs, prevalent published and anecdotal data indicate significant barriers not only to adoption by medical practices, but also to successful utilization of software systems already purchased. The source of these problems can readily be traced to problems with the operability of current designs for the electronic H&P component of EHRs. eHI is ideally suited to convene the stakeholders involved in the electronic H&P, in order to generate the same energy and enthusiasm for designs that promote operability as is has for designs that facilitate interoperability.
The Impact of a Community Wide HIE on the Quality and Efficiency of Care (pdf)
Submitted By:
Robert Keet, MD FACP
Medical Director
Axolotl Corp.
Abstract:
This paper examines the improvement in quality and efficiency of care that has resulted from a 13 year experience of an HIE in Santa Cruz County, California. It examines how building a network of 300 private and public clinic providers with data flowing from: two hospitals, three outpatient laboratories, four outpatient radiology offices and a number of transcription services can impact the delivery of care. It discusses the impact on the data providers, data delivery and management, patient care, office efficiency, and the benefit to the physician organization that originally sponsored the system.
Towards an Adaptive Model of Ambulatory EHR Adoption (pdf)
Submitted By:
Charles, Webster, MD, MSIE, MSIS
Chief Medical Informatics Officer
EncounterPRO Healthcare Resources
Abstract:
Ideas from adaptive systems and computer simulation may be relevant to gaining
better understanding of ambulatory EHR adoption trends. EHR users and other
stakeholders seek to optimize disparate goals during cooperative and competitive
interactions, while also responding to outside incentives. Computer simulations of
technology diffusion and consumer behavior deal with many of the same issues
relevant to EHR adoption—early versus late adopters; social interaction and network
structure, consumer lifecycles, norm establishment, interaction of perceived need
and uncertainty, to name a few—and so may be relevant to better understanding,
predicting, and managing ambulatory EHR adoption trends.
Health Care as Self-Service: Way to Safer, More Effective Care (pdf)
Submitted By:
Jeffery Kendall
Director, Healthcare Solutions
NCR Corp.
Marija Zivanovic-Smith
Director, Government Relations
NCR Corp.
Abstract:
With the growth of consumer-directed healthcare, it is increasingly important for hospitals and health systems to effectively compete in the local marketplace. As patients take greater control of health-related expenditures, enhancing the patient experience to drive consumer preference and loyalty is becoming an imperative. At the same time, healthcare organizations face increasing pressures to reduce costs, increase staff productivity and improve operating margins. By adopting self-service technologies to automate and streamline traditional paper-based processes like patient registration, hospitals can reduce administrative costs; enhance overall efficiency; increase collections; and improve cash flow. Patients also benefit from self-service technology through shorter wait times, less paperwork and increased healthcare quality. Self-service is just one type of health IT. There are many other beneficial health IT systems, including e-prescribing to reduce dangerous medication errors, and tele-medicine to expand health care access. Our policymakers can help foster continued adoption of these health technologies by: 1. Passing Health IT legislation in 2008; 2. Avoiding technology mandates that discourage investment; 3. Encouraging broadly accepted standards for HIT and conducting regular oversight of the process of establishing health IT standards; and 4. Exploring innovative options for healthcare financing.
The Missing Keys to Improving Quality and Efficiency in Health Care (pdf)
Submitted By:
William L. Carriere, M.D.
President
Family Care Partners of North East Florida, LLC
President
CPT Technology
President
Arlington Medical Plaza Ltd.
Chairman of the Board
Northeast Florida RHIO (NEFRHO)
Abstract:
The environment needed to advance the acceptance and utilization of robust EHRs by physicians must include:
- Initial focus on improving primary care functions as the coordinator of care-the Medical Home concept
- Significant financial incentives for specific performance objectives for all stakeholders
- Vendors providing comprehensive IT, EHR software, hardware, technical management, data, and collaboratively agreed upon decision support at the point of care.
- Shared data between the payers and physicians utilizing robust EHRs for the purpose of care management and resource selection resulting in a return on investment for the stakeholders
Informing and Interconnecting Physicians: The Workflow Issue (pdf)
Submitted By:
Bruce H. Taffel, M. D.
Vice President, Chief Medical Officer
Shared Health
Abstract:
To bring the types of sustainable quality improvements and operating efficiencies that transform patient care into the practice environment, physicians must have tools that deliver clinically relevant information at the point of care. Those tools are available, and they are proven to be effective. But integration of these tools into the practice workflow continues to be a significant barrier to adoption. The key to gaining physician acceptance is to seamlessly integrate information tools into existing workflows, rather than disrupting them. This session will examine the obstacles, opportunities and solutions to driving physicians’ adoption of information tools to improve patient care and practice economics.
Improvements in Quality and Efficiency: A More Effective Approach to Information Technology Deployment (pdf)
Submitted By:
Richard C. Mindess, MD
CEO & President
Wellport
Abstract:
Information technology has enormous potential with respect to quality improvement and cost containment in healthcare. Thus far, however, the impact of technology on quality improvement and cost containment has been minimal. One factor is the relatively slow rate of physician acceptance and adoption. Understanding barriers to adoption, attention to workflow, careful pre-adoption planning, appropriately aligned reimbursement models, and adequate post-implementation support and education are critical to successful adoption by physicians and ultimately the desired impact on quality and efficiency.
Looking Beyond Technology: Lessons from Studying IT Effectiveness in Other
Industries (pdf)
Submitted By:
Julia Adler-Milstein
Harvard University
PhD Program in Health Policy-Management Track
Doctoral Candidate
Abstract:
While the potential value from health information technology is significant, it is not yet clear what must be done to fully realize this potential. With limited empirical evidence, it is unclear whether to invest the substantial resources required to fully implement IT nationwide and if so, which approach to take. There is a critical need for more studies of HIT effectiveness, particularly for commonly-available tools. Researchers will face an array of decisions on how to design these studies. The growing body of literature on IT effectiveness in other industries offers valuable insights as well as suggests findings that may be generalizable to HIT.
Eliminating paper: Quantifying the impact of Computerized Clinical Documentation Systems (CCDS) (pdf)
Submitted By:
Ritu Agarwal, M.B.A., M.S., Ph.D.
Professor and Dean’s Chair of Information Systems
Director, Center for Health Information and Decision Systems
Robert H. Smith School of Business
Brian R. Jacobs, MD
Chief Medical Information Officer
Executive Director, Center for Pediatric Informatics
Professor, Pediatrics
George Washington University School of Medicine and Health Sciences
Children’s National Medical Center
Jie Mein Goh, M.S., Ph.D. Candidate
Robert H. Smith School of Business
University of Maryland, College Park, MD 20742
Guodong Gao, M.S., Ph.D.
Assistant Professor, Decision, Operations and Information Technologies
Robert H. Smith School of Business
Christiane Corriveau, MD
Associate Professor, Pediatrics
George Washington University School of Medicine and Health Sciences
Children’s National Medical Center
Paul E. Manicone, MD
Assistant Professor, Pediatrics
George Washington University School of Medicine and Health Sciences
Children’s National Medical Center
Abstract:
In 2004, President George Bush announced his plan to ensure that most Americans have electronic medical records (EMRs) within the next ten years. Since then, many have vociferously argued that the transformation in health care can occur only with the widespread adoption and diffusion of EMRs throughout the healthcare value chain. We are now 4 years past the initial mandate but unfortunately, key players in the healthcare system, from hospitals to physician practices, have lagged behind considerably in adoption rates. Why has the adoption of EMRs in clinical settings been so slow? Our focus is on two key drivers of slow diffusion: one, the business case for the technology has not been rigorously and unequivocally constructed for stakeholders, and two, we lack a clear and detailed understanding of the changes to clinical routines and workflows that these technologies cause. To provide evidence related to the value of EMRs, our research program is focused on conducting studies that aid in the quantification of impact, and illuminate the barriers and facilitators of EMR adoption and use by clinicians. We report the findings from a study designed to assess the impact of implementing computerized clinical documentation system (CCDS) in the Children’s National Medical Center in Washington D.C, a free-standing tertiary care pediatric hospital. We conducted a physician time-motion study and a series of clinician surveys to quantify the impact of electronic clinical documentation in a rigorous and systematic way.
Better Evidence on Outcomes and Effectiveness through Analytics (pdf)
Submitted By:
Brett S. Kilpatrick
Chief Executive Officer
AnalytiCare
Abstract:
Inherent in the process of reimbursement, one of the most powerful datasets in all of Healthcare is collected (MDS). When combined with other datasets available to the Long Term Care provider (Pharmacy, Laboratory, Demographics), a new opportunity presents itself. The analysis of combined data, made practical by using techniques and tools perfected in technology forward industries (Retail, Finance), can now provide evidence based support of key decisions processes. This paper entertains issues and opportunities using your own data, in never before available analysis, to improve appropriate reimbursements, enhance survey results and save significant costs while improving clinical outcomes.
Reluctant Technologists or Smart Consumers? – Why Physicians haven’t jumped on the EMR band wagon and Why EMRs are not consistently associated with Care Improvement (pdf)
Submitted By:
John Haughton MD, MS
CE) / CMO
DocSite, LLC
Abstract:
Five years ago, improved care seemed nearby. Electronic Medical Records (EMRs) were the solution. Articles showed 50% failure rates for chronic and preventive care metrics. Medicare and commercial payers poured resources into physician offices for EMR adoption. Yet, quality and efficiency still suffer. EMR adoption in small offices hovers around one in ten and care delivery excellence continues to be inconsistent. As a nation, we emphasized adoption of electronic documentation systems. For excellence and use, solutions must focus on improving care while saving physician time. Going forward it is critical to incent interconnected systems that highlight decision support in the point of care workflow; measure the effectiveness of care delivered and offer methods to find patients whose care falls short of desired, the elements proven to improve care through use of health information technology.
Saving the American Healthcare System…Is it worth it? (pdf)
Submitted By:
Douglas J. Jorgensen, D.O., C.P.C., F.A.C.O.F.P.
President
Patient360, LP
Abstract:
Saving the US Healthcare system permeates politics and talk in American households. Achieving this requires conceptualization of numerous variables impacting care, care processes, money and collaboration of all parties involved. The current system is broken, with fingers pointing in all directions; doctors, patients, insurers, the government. Health information technology (HIT) is a virtual mandate to achieve success, yet agreement on what works, how to implement it and most pragmatically, how to pay for it belies any potential for success. The US Healthcare System is one of greatest systems in the world, yet how it is evaluated, the means by which the data is collected and how we define ‘success’ remains to be seen and will resonate for decades to come at this most critical juncture.
A Proven Model for Electronic Health Data Exchange: Immunization Information Systems (IIS) and the American Immunization Registry Association (AIRA) Community of Practice (pdf)
Submitted By:
Cynthia Sutliff
Executive Director
American Immunization Registry Association (AIRA)
Abstract:
The interstate use of IIS during Katrina, lauded by Secretary Leavitt, provided access to immunization records for children displaced to other states, facilitating their school attendance in a timely manner and saving the healthcare system an estimated $3.04 million in vaccine costs.
Critical success factors—adoption of functional and technical standards and a trusted community (AIRA)—facilitate both emergency and routine exchange of immunization data between public and private stakeholders, including providers, health plans, and schools, and strongly support AHIC focus areas EHR, PHR, and Biosurveillance with infrastructure and lessons for data exchange. History, processes, successful examples, and challenges are described.
Accelerating Healthcare Interoperability Through Open Source Promotion and Adoption – A Value Proposition & Policy Recommendation (pdf)
Submitted By:
Timothy Elwell, MBA
Vice President
Misys plc
Alesha R. Adamson, MSc
Victor Liu
Abstract:
We examine ways to accelerate the adoption of EMRs through the building of RHIOs using open source technologies. We look at the historical adoption of the World Wide Web and its associated ‘network effects’ that promoted the exponential growth of the Internet. We extrapolate the potential acceleration of the adoption of EMRs through an examination of Metcalfe’s Law. We point to research that demonstrates that the use of open source solutions will increase the adoption of RHIOs by 20% by 2014 -- effectively increasing the capacity of RHIO coverage from 48% to 60% of the country – supporting a policy recommendation.
Building a Health Information Exchange that is Self Financing: A Different Take on the Past and Future! (pdf)
Submitted By:
Margaret P. Ezell, Ph.D.
VP - Regional Sales
Universata, Inc.
Clinton Laird
CEO
Universata, Inc.
Eric Barnum
President and Founder
Universata, Inc.
Mark Ferrel
CTO and Founder
Universata, Inc.
Susan Pletcher, RN, MPA, CHAM
HIS Director
Medical University of South Carolina - Health
Abstract:
The goal of a national Health Information Exchange (HIE) faces many challenges for accessing and exchanging personal medical information. Chief among these are setting standards for systems interoperability further confounded by understanding the direct financial costs and service disruption costs in adopting electronic medical records. It is proposed that these two (2) fundamental challenges have been solved via new, disruptive integration technologies and an existing revenue model found in the Release of Information (ROI) industry, which is the platform process for requesting and fulfilling medical record requests (i.e. the HIE) in a HIPAA compliant process. Universata is an IT company that saw the convergence of technology and ROI in 2003 and designed technologies and business partnerships so as to become the national HIE. This paper is designed to introduce solutions to the challenges of the national HIE and invite discussions with prospective HIE stakeholders who could partner with Universata to deploy its HIE technologies in a federated model that builds on and respects existing customer relationships.
Making Meaningful Progress Toward HIE (pdf)
Submitted By:
Larry Watkins
Vice President, Standards & Regulatory Affairs
Ingenix
Abstract:
Health Information Exchange (HIE) is a long-term vision that results in interoperability that will improve health care processes with respect to safety, quality, cost, and other indicators. Progress is being made through planning, pilot programs, standards adoption, and implementing HIE technologies of varying degrees of sophistication. A number of voluntary industry efforts show promise; however, we are still a long way from realizing the goal. The fact is, building a truly interoperable national HIE is not easy, either culturally or technically.
The key to reaching the HIE goal is capitalizing on necessary tools, standards and resources that meet current practical (funded) objectives in such a way that incrementally creates an HIE infrastructure. Then, organizations can add capacity and functionality in order to accommodate complex, bandwidth-intensive clinical information and connectivity, interoperability, and security mechanisms.
Myths and Facts About HIPAA and Health Privacy (pdf)
Submitted By:
Deven McGraw
Director of Health Privacy Project
Center for Democracy & Technology
Abstract:
This paper is Part 2 of CDT’s ongoing effort to address common myths about HIPAA and health privacy, which can be a barrier to productive discussions about how to enhance protections for personal health information. The original version debunked the myths that arose just after the HIPAA Privacy Rule was implemented. This second version addresses more recent myths and covers the right to privacy, patient consent and rights, enforcement, protection of health information on the Internet, the interaction between HIPAA and state laws, information disclosures to employers, marketing, and de-identified data.
Realizing Health Information Technology's Potential (pdf)
Submitted By:
Stephen E. Beller, Ph.D.
CEO/President
National Health Data Systems, Inc.
Abstract:
Health information technology (HIT) was predicted to control healthcare costs and improve care quality, but results show much room for improvement. Adoption rates are very low and those using HIT have seen poor to mediocre return on investments. Much can be improved by realigning economic benefits, having a better way to handle standardization, and using a cohesive HIT implementation strategy that encourages innovation. This paper discusses HIT’s potential and evidence of its benefits; explains why adoption has been slow; and examines the need for a big picture blueprint. It then presents a new, comprehensive roadmap for achieving the initial predictions.
HIT-enabled benchmarking technology: A discussion of the potential, its implications, and policy options (pdf)
Submitted By:
James A. Cooley
Office of Medical Technology
Office of the Medical Director for Medicaid/CHIP, Texas Health and Human Services Commission
Abstract:
Few innovations in technology have greater potential to transform medicine more than health information technology (HIT)-enabled benchmarking. Large medical databases coupled with electronically-submitted information from disparate sources and powerful analytics tools have the potential to allow us to compile and compare benchmarks across our healthcare enterprise. Understanding the full potential of these new tools is critical for health care policymakers. What are the benefits, implications, and policy options that present themselves regarding the integration of modern HIT-enabled data gathering and modern analysis tools into the health care system? This overview briefly summarizes some of them and offers possible next steps.
Caveat: The views in this article are not to be taken as an official policy statement from my agency. I have to state that because we have a process for issuing formal policy statements. The paper is one I am submitting with my agency’s knowledge, but I am not speaking on their behalf in it. If it is published, I have to make that distinction clear.
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