The way forward for health IT

NGP’s Rebecca Goozee speaks to Scott Wallace, President and CEO of The National Alliance for Health Technology about improving health IT.

cott Wallace became President and CEO of The National Alliance for Health Information Technology in 2003. Armed with no previous knowledge of IT, healthcare or not-for profits, he was perhaps not the most obvious choice for the role. However, it was his business insight and perspective as a technologist that has helped accelerate the pace of health IT adoption and led him to be named three times in Modern Healthcare magazine’s “100 Most Powerful People in Healthcare.”

After laughing about his previous qualifications, Wallace explains why his perspective was so important. “There’s a lot of technology in healthcare, but there’s not a lot of understanding by many people in healthcare about how technology works in the rest of the world. My background was so different to what most people in the healthcare circle have, and so I brought a view of how business outside of healthcare uses and has used technology. I took this not only to healthcare people but also policy leaders within the US to round out their understanding and give them views of what works elsewhere in the world and what might be useful in healthcare.”

Improving healthcare outcomes
Healthcare at its most basic level is a series of information exchanges. A patient goes to a care provider and explains what’s wrong. They give information about their own situation and that care provider takes that information and processes it together with other information from various sources. The care provider then comes up with a plan about what to do with the patient and conveys that information to the patient. “It’s information exchange all around, yet healthcare does a poor job managing information flows,” explains Wallace. What the Alliance has tried to focus on is to improve the information flow between patients, providers and payers throughout the network.

Wallace highlights the fact that in order to become more fully connected, the mindset of leadership needs to change. Senior leaders across the spectrum of healthcare – hospital leaders, physician leaders, the payer community and the government – need to recognize the centrality of information; indeed, to become committed to the idea that part of their role as leaders is to figure out ways to improve information portals. “If they start doing things at a senior level, then all of sudden, the other pieces all start falling into place,” summarizes Wallace.

Wallace goes on to explain that it is difficult to pinpoint a time when the healthcare system will become fully connected. “The idea that we can somehow flip a switch and we’ll all be connected leads to bad policy decisions and bad business decisions,” he stresses. The more effective way to look at the problem is to improve information flows in one critical area at a time, then keep building on those foundations. “One of the things that has happened in the States is a healthcare big bang theory that we’re going to sprinkle pixie dust around and all of a sudden, we will have a transformed healthcare system,” says Wallace. Rather, according to Wallace, we should be looking at the situation as a layered cake, being built incrementally as opposed to one big pie that gets served right away.

Advantages of EHRs
Wallace suggests looking at electronic healthcare records on two different levels in order to understand their usefulness. With more people starting to use these tools, the more they start to realize all of the different bits of information that need to be collected. “Starting with an in-patient,” explains Wallace, “there is a hospital health record that describes what was done to the patient while they were hospitalized. But then maybe there’s other information that would be useful to have to, such as what immunizations the patient has had, what tests they have they had in the past. And, expanding more broadly, what kind of genomic information can we put in there?”

Looking at it from another perspective, you have an electronic record and for it to be valuable, many people have to be able to access it and extract data in useful ways. How do you start making this system more and more useful to people who can improve and impact the quality of that patient care? And how will different providers be able to pull information out in useful formats? “These are the two issues that people are really struggling with,” says Wallace. “How do we feed information in and then keep that information confidential yet provide it to the caregiver? Once we have figured out the answer to this, we will end up with a useful system.”

In terms of uptake, the provider community in the US has made a real shift in the last couple of years, recognizing that the tools out there can be really helpful. The payer community is starting to understand that the effective use of this new technology can lower the cost of care delivery. “The next big hurdle is to get consumers to embrace EHRs and start demanding their use,” states Wallace. As the healthcare system is almost exclusively private payers, every time you visit a care provider, you have to give them insurance information. “In my case, my insurance information hasn’t changed in five years, yet every single time I turn up, I have to give them the same little piece of plastic. That gets irritating. If we get enough patients expressing irritation, then perhaps it will drive more uptake by the provider community,” suggests Wallace.

Cost issues
Many smaller practices and community health centers believe the cost of adopting EHRs is excessive. Wallace believes there are a couple of different cost elements to take into account when considering EHRs. There is the acquisition cost of the system itself and then there is the use cost. The use cost is dramatically greater then the acquisition cost. “My physician has a computer under her desk and maintains an EHR on that computer,” explains Wallace as an example. “This is terribly inefficient way to deliver health IT. What we are looking for is a much more distributed web-based system, where infrastructure costs are spread across a large number of people.”

Wallace goes on to explain that the much greater cost is transformation of the care processes to make the use of EHRs effective. The costs are dominating at the moment and they will continue to be big costs, but the costs of improvement, of giving better, higher quality healthcare, will be immeasurable.

Supply chain
The supply chain is really central to healthcare. There are some forecasts that predict the cost of supplies will soon outstrip the cost of labor in care delivery. Because healthcare delivery is such a complex undertaking, the supply chain is difficult to manage, and by and large, hasn’t got a great deal of attention for efficiency improvement. The AllianceI has put together a group of interested organizations that are looking at ways to implement standardization in the supply chain to streamline it and make it more efficient by bringing modern management and supply chain management into healthcare. “Our group  already has taken the important step of endorsingd data standards for identifying organizations and products. Over time, it will expand beyond that to standardizing other key pieces of the supply chain,” explains Wallace.

Outlook
In terms of the healthcare IT of the future, Wallace predicts that the industry will become more and more sophisticated in its use of information. Looking at other industries, all the models point toward greater sophistication, and Wallace can’t see any reason why healthcare would differ from that. He hopes that groups like the Alliance become irrelevant. “I hope that information management in healthcare becomes such that focusing on it as a separate issue is no longer necessary. We’re probably a ways from that, but that is my grand aspiration – not to be needed.”

The National Alliance for Health Information Technology is a non-profit, member-based organization focused on how healthcare information technology can and will improve healthcare outcomes. Founded in 2002, the Alliance is a unique forum in which senior leaders convene, speaking candidly about emerging issues in healthcare and working collaboratively to create consensus-based solutions and action plans. Alliance membership represents organizations from leading academic medical centers, hospitals, ambulatory care providers, IDNs, health systems, payers, purchasers, technology vendors, supply chain manufacturers and suppliers, consultants, associations and other aligned stakeholders invested in realizing a connected healthcare system.

Electronic health records are interoperable, assembled and accessed in real time and can include:

• Patient demographics
• Longitudinal record of a patient’s medical history, examination and progress reports of health and illnesses
• Medicine and allergy lists, and immunization status
• Laboratory test results
• Radiology images (for example x-rays, CTs, MRIs)
• Photographs, from endoscopy, laparoscopy or clinical photographs
• Medical information, including side-effects and interactions
• Evidence-based recommendations for specific medical conditions
• A record of appointments and other reminders
• Billing records
• Advanced directives, living wills and health powers of attorney

Since assuming the executive leadership of the Alliance in 2003, Scott Wallace has become a fixture in Washington and other policy circles as a voice for the potential of information technology to solve problems related to cost, efficiency and effectiveness of medical care and health management. His legal and entrepreneurial background complements a knowledge of healthcare issues, positions and players.