EMRs, EHRs and new technologies in IT healthcare

Mark Anderson is one of the nation’s premier IT research futurists dedicated to healthcare.

He has been in the healthcare industry for a little over 34 years, starting out as a management engineer and climbing the healthcare ladder to a Chief Information role, before becoming CEO of A C Group, which specializes in looking at clinical and financial software products, and helping physicians and hospitals make the right decision on selecting those applications. Mark shares his thoughts on the IT sector of the healthcare industry with EHM.

EMR v EHR

If you think about the EMR, standing for Electronic Medical Record, it is really the collection of the medical information for treating that one patient for whatever problem they are running into today, it could be a sprained ankle, it could be a cold, whatever. Versus an EHR, Electronic Health Record, which is looking at the health of the patient, knowing more about them than not only this one incident but all the healthcare they have received over their lifetime, whether it was in a hospital setting, an emergency room setting, in the physician office, the home help agency. It tracks the health of the patient with an emphasis on trying to keep the patient healthier whereas an EMR tries to resolve the medical issue that the patient is facing today. We need to move towards more of a healthy environment, more of an EHR approach, so we can start keeping people of the United States healthier.

Interoperable records

We have to find ways of sharing data between multiple physician offices and multiple hospitals and the only way to do that is with some kind of nationwide standards that can share data between multiple settings. What’s it going to cost? Well it is going to be expensive, there is going to be a cost of probably about 30 percent more to be interoperable, but the overall savings to the healthcare industry is in the billions of dollars if we have this happen.

The problem is the physicians are asked to pay for the software and they receive none of the financial incentives for using the software, therefore, adoption for interoperability might happen as far away as 2012, before we really have 40 – 60 percent of the patients being seen in an interoperable setting – we need to do it today but we have to align the financial incentives for the physicians who have to spend the money to do all this work.

Sponsorship

Sponsorship is probably the solution to the financial burden of software. Previously, the Stark Law prevented hospitals from providing financial incentives for the doctors to use a specific technology, however, the Stark Law restrictions have recently been reduced which now allows the hospitals to go out and provide a financial incentive for the doctors to purchase these systems. Traditionally, the hospital buys this system and then rolls it out to the individual physicians out there. It sounds great, the only issue is that if there are multiple hospitals in the city – which is true of most cities – then multiple hospitals are going to offer multiple software products to the doctor and the doctor is not going to be able to work with multiple systems, they are going to have to pick one over the other. It is very hard for the physicians to align with just with one hospital because the healthcare plan dictates where those patients can go and what hospitals they can go to.

Challenges

The biggest challenge out there is the word ‘change’, you will find that most of the people in healthcare really don’t want to change, they like progress but they hate change. To make technology really work we have to align the clinical and financial incentives with ways of improving healthcare, and the only way technology is really going to be embraced is when we do that alignment.

Adoption

In terms of technology, the biggest thing is going to be that as doctors start adopting more and more technology it will reduce the number of errors that are occurring when patients go to multiple doctors. Most doctors themselves do not make errors but the Institute of Medicine talks about these hundreds of thousands of errors that occur each year which are probably because as a patient goes from one doctor to another doctor data does not flow between them effectively. Adopting technology will allow this exchange of clinical information between multiple providers out there – that is where the value is really going to be.

Survey

The original goal of the PMS, EHM and Community Health Record Functionality survey was that with 300 vendors all claiming they have the best application, we had to find a way of actually measuring or quantifying how good each application was. We created a survey that dealt with 3,000 functional questions on the EMR side and 1,500 on the practice management side. We were then able to pull back value, we call it relative value unit, for each one of those questions which meant we were able to determine which vendors really do provide the best functional detail requirements that are out there in the industry today. It is like saying everybody has a great product but how do you measure it – we now are able to measure that. Has is been successful? We believe so because if we go back and look at all the vendors that are the highest rated in winning the awards and the ones that are selling the most, they are getting the best results in our survey. There are probably about 50,000 to 60,000 doctors a year using our surveys as a sounding board on which vendors they should look at.

HIPAA

The HIPAA (Health Insurance Portability and Accountability Act) regulations have been pretty solid out there for quite a while, well the ones that have actually been established, and we will go through and evaluate the vendors on well they meet the HIPAA requirements and now we also look at how well we meet HIPAA requirements for these community data exchanges. We exchange data between multiple practices – that is the part that is really being tested today – how can we exchange data between multiple groups and how do we get the patient and their privacy protected doing that. There are a number of vendors that are doing it very well today.

Future

We need to get broad adoption of interoperability relatively soon, we predict that if we can change the financial incentives around the healthcare industry we can focus on keeping people healthier. The healthcare industry alone can save 22 percent and 22 percent of $1.5 trillion is a heck of a lot of money. However, we have to find the incentives. We can’t save money in one location and make other people absorb that cost, we have to really get the physicians, the hospitals, the healthcare plans and primarily the government all working together to move towards a common strategy – there’s been a lot of talk about it but there hasn’t been a lot of action. My prediction is that we really need more action not more talk.

Source: Tom R. Shepherd, Information Technology Department, 401 S.W. 7th St. Suite N, Des Moines, IA 50309-4611, tom.shepherd@itd.state.ia.us

“you will find that most of the people in healthcare really don’t want to change - they like progress but they hate change”

“we really need more action not more talk”