In a series of articles written for the ACHE, I focused on Technology Trends that the CXO's should be aware of. Making the assumption that most CIO's are aware of these and include them in their current leadership practice - this feature article is more directed at the CEO, COO, CNO, etc. I hope you find these selected updates of value...
As pressure increases to raise profits by cutting costs, small to medium-sized businesses (SMBs) that provide healthcare products and services are looking to several technology solutions to increase patient safety, reduce medical errors and improve bottom lines, stated the Information Technology Solution Providers Alliance (ITSPA), a national, non-profit alliance that helps SMBs understand how technology and local technology providers can help them succeed. "Several key drivers are expected to increase healthcare IT investments by 8-10 percent yearly including improving workflow efficiencies, billing and payment systems, revenue collection and management, regulatory compliance, patient records integration and links between financial and clinical systems.
The Certification Commission for Healthcare Information Technology (CCHIT®) has gained substantial momentum since the organization's founding in 2004. As a result, buyers of electronic health records (EHRs) - or electronic medical records (EMRs), as they are also known – the role of this Commision is to certify EMR and Clinical software technology against function, and performance standards.
Chartered by the Office of the National Coordinator (ONC), the Healthcare Information Technology Standards Panel (HITSP) was established to identify interoperability standards that enable widespread HIT interoperability. To achieve this, HITSP works in a collaborative effort with standards development organizations (SDOs). As HITSP leads the effort in systemic interoperability, the Certification Commission for Health Information Technology (CCHIT) ensures that EHR systems support key functional requirements and comply with HITSP identified standards Healthcare is undergoing an historic shift: a shift from one-size-fits-all healthcare to one-to-one healthcare. The mapping of the human genome is bringing about massive changes in the practice of medicine," says Jeff Bauer, PhD healthcare futurist at ACS, a leading provider of business services to the public and private sectors.
All that data brings a need to process and analyze it. "There's more data than any one person can keep in their minds. We can expect a rapid proliferation of technologies at the bedside, in the laboratory, throughout the entire healthcare setting. Imagine information technology fueling personalized predictive medicine," continues Dr. Bauer. "This will require new devices, telemedicine, the ability to transport - if not the patient - then at least loads of data about the patient directly to their doctors or other healthcare professional anywhere in the world." At every level, healthcare, while providing more, also demands more. More data, more analysis, more systems. More money. It's not that technology and innovation alone are driving up healthcare costs, per se. These often require capital investments, but over the long term most end up improving productivity and ultimately reducing costs. At the same time, regardless of the source, healthcare costs nationwide have consistently grown at a much faster rate than the overall economy. In February, the US Department of Health and Human Services reported that it estimates healthcare costs will more than double of the next 10 years, rising from $2.2M in 2007 to $4.3M by 2017.
The quality of healthcare and the safe practice of delivering healthcare services have garnered much attention in both healthcare journals and the media at large. Healthcare’s importance has taken center stage in this year’s Presidential election contest.
Wrong patient and wrong site surgery, medication errors, pressure ulcers, central intravenous line (IV) infections, and antibiotic resistant infections such as Methicliin resistant Staphylococcus aureus (MRSA), are only a few of the high profile issues that have healthcare industry leaders talking. Over the years healthcare regulating bodies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and local Departments of Health have spearheaded multiple patient safety initiatives in an effort to mitigate errors and improve patient safety. Even with the advances healthcare.
Unified or enhanced communications is the buzz du jour in our industry, but there are a lot of different ideas out there for what it actually is and what it is good for.What everyone seems to agree on, though, is that there are two key drivers that fuel the need for the application of unified communications in healthcare IT: reducing clinical errors through enhanced communication and improving collaboration across healthcare service providers. The real buzz should therefore revolve around “integrated” unified communications in medical imaging, with a capital. Missing deadlines due to ineffective communications in healthcare can be deadly. According to a survey done by the Joint Commission in 2006, ineffective communications is the primary root cause to sentinel events like wrong-site surgery, medication error and delay in treatment. As a matter of fact, ineffective communications has been the No. 1 root cause to sentinel events for the last 10 years from 1995 to 2005 in the same survey. For example, in the field of radiology, delays and failures in communicating critical patient findings from reporting radiologists to ordering physicians can threaten patient safety.Unified communications also plays an important role in improving collaboration within the realm of medical imaging; expertise in diagnostic imaging is in short supply, and these skill sets are becoming more and more geographically dispersed. Every minute engaged in tracking and locating others introduces a bottleneck in delivering the service and compromises productivity. Therefore, every opportunity in making it easier to communicate, consult and collaborate when delivering a diagnostic imaging service can improve patient care and can increase the competitiveness of the provider’s business. Even as the U.S. health industry has been laying the foundation for a national health information system to electronically exchange clinical and patient information, a parallel movement has been taking shape and focusing on the healthcare supply chain. It represents a historic opportunity to leverage IT to reform the supply chain and yield billions of dollars in savings while significantly strengthening patient safety and improving care outcomes.
Like efforts to use IT in support of the transformation of clinical care, reinventing the supply chain is of strategic importance to every single healthcare participant. To succeed, the supply chain reinvention effort needs visionary leadership and commitment from healthcare senior executives, not only the supply chain professionals they have managing such functions as logistics, purchasing and IT.In some ways, the healthcare supply chain is in more dire need of IT-supported innovation than are clinical processes. The current series of transactions that takes a syringe, an IV bag, a pacemaker, a hospital gown or an ultrasound machine from the manufacturer to the patient relies on product information that is recorded differently by almost every trading partner at each step in the supply chain. It is commonplace for different departments within a single organization to have multiple identification numbers for the same manufacturer or product.
Continuous escalating healthcare costs nationwide highlight the need for change within the United States healthcare system. Many solutions have been proposed and it seems that broader use of health information technology (HIT) is seen as a prime catalyst for transformation. Electronic health records (EHRs), systemic interoperability and automated clinical decision support are the three other key components in the transformation mix. EHR converts paper charts to digital form; interoperability allows disparate systems to exchange records; and decision support provides safeguards and recommendations to clinicians at the point-of-care based on information available from these multiple interoperable systems.Industry theory tells us that full realization of HIT will prevent procedural redundancy, reduce errors, decrease medical costs and yield better patient care. These benefits multiply as the data involved is drawn from a larger array of sources, ranging from a single provider system to larger, interoperable networks such as a regional or nationwide health information exchange (HIE).If the benefits are clear, why is the industry struggling with widespread adoption? It’s because HIT adoption is fraught with challenges. Multiple factors impede success, including competitive friction, regulatory barriers, leadership voids, and lack of funding and sustainable business models. To overcome these barriers and achieve sustainable HIE, industry stakeholders at all levels must innovate and collaborate. Continued focus on formalizing interoperability standards to harmonize systems is imperative in creating a nationwide HIE. America's Healthcare Organizations are building company-wide business strategies designed to sustain security while achieving efficiency and effective improvements. In today's challenging regulatory and healthcare environment, a key challenge is integrating processes and metrics used to monitor adherence to regulatory requirements with those used to understand risks and manage enterprise performance. Database security performance and access is now a mainstream part of the healthcare business strategy that addresses operational practices, from procurement and implementation to delivery of services to the organization. There are more features associated with next generation IT Security than ever before. With the ever changing world of regulatory guidelines comes equally evolving technology. Revitalizing modern solutions is the pinnacle of a quality security initiative, however there's also the need to maintain current solutions that can embrace a progressive technological age.
EMR Adoption ModelSM-
HIMSS Analytics, the authoritative source on EMR Adoption trends, devised the EMR Adoption Model to track EMR progress at hospitals and health systems. The EMRAM scores hospitals in the HIMSS Analytics Database (derived from the Dorenfest IHDS+ DatabaseTM) on their progress in completing the 8 stages to creating a paperless patient record environment.
The Stage ( from 7 to 0) and Descriptions are as follows:
Stage 7. The hospital has a paperless EMR environment. Clinical information can be readily shared via Continuity of Care (CCD) electronic transactions with all entities within health information exchange networks (i.e., other hospitals, ambulatory clinics, sub-acute environments, employers, payers and patients). This stage allows the health care organization to support the true sharing and use of health and wellness information by consumers and providers alike. Also at this stage, HCOs use data warehousing and mining technologies to capture and analyze care data, and improve care protocols via decision support.
Stage 6. Full physician documentation/charting (structured templates) are implemented for at least one patient care service area. A full complement of radiology PACS systems is implemented (i.e. all images, both digital and film-based, are available to physicians via an intranet or other secure network.)
Stage 5. The closed loop medication administration environment is fully implemented in at least one patient care service area. The eMAR and bar coding or other auto-identification technology, such as radio frequency identification (RFID), are implemented and integrated with CPOE and pharmacy to maximize point-of-care patient safety processes for medication administration.
Stage 4. Computerized practitioner/physician order entry (CPOE) for use by any clinician added to nursing and CDR environment. Second-level of clinical decision support related to evidence-based medicine protocols implemented. If one patient service area has been implemented CPOE and completed previous stages, this stage has been achieved.
Stage 3. Clinical documentation installed (e.g. vital signs, flow sheets, nursing notes, care plan charting, and/or the electronic medication administration record (eMAR) system are scored with extra points and are implemented and integrated with the CDR for at least one service in the hospital.
First level of clinician decision support is implemented to conduct error checking with order entry (i.e. drug/drug, drug/food, drug/lab, conflict checking normally found in the pharmacy).
Some level of medical image access from picture archive and communication systems (PACS) is available for access by physicians via the organization's intranet or other secure networks.
Stage 2. Major ancillary clinical systems feed data to clinical data repository (CDR) that provides physician access for retrieving and reviewing results. CDR contains a controlled medical vocabulary (CMV) and the clinical decision support system and rules engine for rudimentary conflict checking. Optional for extra points. Information from document imaging systems may be linked to the CDR.
Stage 1. Laboratory, pharmacy and radiology installed.
Stage 0. Some clinical automation may exist. Laboratory and/or pharmacy and/or radiology not installed.
References:
Lundstrom, Mon, Garretts,http://www.futurehealthcareus.com/?page=its-concept, 2008.
HIMSS Analytics, EMR Adoption ModelSM , http://www.himssanalytics.org/hc_providers/emr_adoption.asp, 2008
Mike Davis, HIMSS Analytics, Trends ppt, http://64.233.169.104/search?q=cache:FrvvCTbHGOEJ:www.chimss.org/downloadlibrary/doclibrary/CHIMSS_June_06.ppt+healthcare+it+trends&hl=en&ct=clnk&cd=29&gl=us, 2006
Best,
Don Lyons
InterOPERANT
CEO and Managing Partner
Wednesday, July 2, 2008
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