Wednesday, February 23, 2011

Show Me the EMR

Remember that great scene in "Jerry Maguire" where Tom Cruise is pleading with Cuba Gooding Jr. to get his act together? The two are in the locker room and Cruise utters those famous words, "Help me, help you. Help me, help you."

Well, that's sort of the message that Secretary Kathleen Sebelius delivered this morning during her keynote address. Speaking to a packed room, Sebelius called on attendees to become more vocal advocates—and partners—in making sure that health IT truly transforms care delivery. She called on the health IT community to actively promote IT solutions not as just IT, but as tools to improve workflow, patient safety and quality of care. She also urged larger providers and vendors to reach out to smaller physician practices and hospitals to help them become meaningful users. And, importantly, she said we need to ensure that health IT is used to close the gap we see in health care disparities.

Sebelius also pointed out that many of the goals of the Affordable Care Act without robust—and meaningful (there's that word again)—health IT systems.

"Health reform needs health information technology," she said, and vice versa. She astutely noted that the market for health IT will be determined by how well hospitals, doctors, nurses and other use the technology.

David Blumenthal, M.D., followed Sebelius, but didn’t really break any new ground. As many of you probably know, Blumenthal will step down this spring as national coordinator for health IT. He's returning to Harvard. His speech was very similar to one he delivered at our Rural Health Leadership Conference earlier this month. He rattled off a series of accomplishments and challenges and reiterated his belief that meaningful use has the potential to transform care delivery like no other program in history.

That's been a consistent theme this week: that we have to move away from thinking of meaningful use as an IT deployment and begin to understand the potential for improving patient safety and quality of care.

"In many ways, ARRA is incenting us to do the things that we should be doing anyway," Karen Thomas, VP and CIO at Main Line Health, a Pennsylvania-based health system, told me when we sat down to chat yesterday. We can debate some of the specifics of regulations, but the overall intent is to push hospitals and doctors to get to the next level, and that's the right goal, she said.
Tuesday, February 22, 2011

Making Your CIO Irrelevant

It may be surprising to hear this at an information technology show, but there's some suggestion here that CIOs will go the way of the dinosaurs. OK, that might be an exaggeration. I don’t think my five-year old son will be digging up your CIO's bones when he becomes a paleontologist in 20 years or so. At least I hope he won't!

At any rate, there’s been a healthy and useful discussion throughout some of my meetings about the changing role of the CIO. Or more to the point, the need to make health IT to be a clinician-led endeavor.

"We’ve been given a sacred responsibility," William Bria, M.D., chief medical information officer at Shriners Hospitals for Children said last night a dinner event held by AHA Solutions. "We need to realign our goals," he said around patient care, not around CMS' goals or incentive payments or other political priorities. To do that, physicians needed to be front and center.

David Muntz, VP and CIO at Baylor Health Care System, and Tom Balcezak, M.D., associate chief of staff at Yale-New Haven Hospital, who shared the podium with Bria concurred. Muntz added that for years the CIO's role has really been the Chief Data Officer. That has to change. Technology needs to provide clinicians with useful information, not just data for data's sake.

"We need to get IT as part of the overall clinical team," Deane Morrison, CIO at Capital Region Healthcare, which runs the 230-bed Concord Hospital. He said CIOs—and the rest of IT—need to essentially let clinicians lead projects and get the credit for successful deployments. It's also imperative to change the focus from an IT deployment to outcomes and improved care, said John Frownfelter, M.D., CMIO at Henry Ford Health System. Both Morrison and Frownfelter spoke during a breakfast sponsored by McKesson. Interestingly, both men said that their hospitals are unlikely to apply for meaningful use incentive money in fiscal 2011 and part of the thinking is making sure that their IT objectives mesh with their overall clinical goals.

The issue of clinician engagement is also coming up with vendors. Some are beginning to recognize the need for practicing docs and nurses to be involved in product design. It saves everyone time and money in the long run, says Angie Franks, president and CEO of Healthland, which sells IT solutions to rural hospitals. In developing its new CPOE product, for instance, Healthland recruited 23 docs from 23 hospitals to be involved in product development from the start. Healthland let the docs hammer out different workflow issues. They used the same process for a nurse documentation system. The process may have added to the product development timeline, says Franks, but it has resulted in a product that won't need to retooled and retooled again.
Monday, February 21, 2011

Making IT Meaningful

We've heard it time and time again: meaningful use shouldn't simply be about meeting the strict letter of the law; rather it should be about the broad intent of the law. That's the message coming through on day one at HIMSS11.

It is how C. Martin Harris, M.D., chief information officer at the Cleveland Clinic, and HIMSS board chair, kicked things off this morning at the keynote session. He noted that health IT should be a tool to enable clinicians to improve quality and safety. It shouldn't just be about putting certain modules in place and checking off a box on the regulatory checklist.

To a degree, it appears that HIMSS members get the message. The society released its annual leadership survey this morning (we'll provide a link once it is on the HIMSS website) which showed that meeting meaningful use and improving patient care were the top two business objectives for respondents (326 people representing 700 hospitals filled out the survey). As Harris said during a press briefing, you can't really separate meaningful use requirements and improving patient care, though. They are woven together.

But there still seems to be a pretty wide gulf between what vendors are pitching and clinicians want. I sat in on an event Harris had with a group of 25 or so physician leaders and they peppered him with questions about why the technology doesn't seem to match with their clinical experience. One physician noted that before treatments or procedures are embraced by docs, they get studied and studied some more and then published in peer review journals. The same is not happening with health IT. Harris acknowledged that there is a void when it comes to credible data on the true impact of health IT. He said there is a need to better understand how it impacts care and workflow. He also urged the physicians to work more closely with the IT departments—and subsequently vendors—to make sure that products meet their needs.

The Health Care Bubble

OK, let me just get this out of the way now: I am not a big fan of Orlando. Here's my theory on Florida: the state’s biggest selling point is that there are two coasts. So why would anyone choose to live in the middle of the state?

That said, I'm happy to be here enjoying sunshine and 70 degree temps (well, I can see the sunshine when walking through the convention center concourse). It's been a long winter up in Chicago!

My week-long visit to Orlando actually started on Sunday with the CHIME's CIO Forum. About 530 CIOs, vendors and other senior technology officials were on hand to network, get an overview of health information exchange and hear a sobering diagnosis of the nation’s health care market. Nate Kaufman, managing director of Kaufman Strategic Advisors, delivered an opening keynote and he did not pull any punches. He described the stark realities of the country's economic situation and how that will impact health providers: government payments will continue to shrink, the ability to cost shift to private insurers is disappearing and greater accountability for outcomes is coming your way.

"We are in a health care bubble," he said, explaining that a bubble is when you have exceptionally high market prices that can't be supported by fundamental economics. Now, I'm not an economist, but I guess that mean prices far exceed value. We saw it in IT and housing and we know what happened to those sectors and, more importantly, the overall economy. He said providers need to start planning now for the health care bubble to burst. That means avoiding some deadly sins: absence of alignment around a shared mission and vision, cognitive dissonance and institutional self-deception.

In other words, it's time to start aligning your goals/mission/vision with physicians and other providers and be sure you are equipped both culturally and operationally to respond to changing market demands. The Affordable Care Act and meaningful use are, at their core, about adding more accountability to the quality of care. That pressure is not going away.

"Winners," Kaufman said, "will be high-functioning, digitally connected, physician-lead, evidence-based, and patient-centered organizations."

During the lunch break the folks at my table were pretty unanimous in their opinion that while stark, Kaufman's speech painted a realistic picture of things to come and was something they said they needed to hear.


Matthew Weinstock
H&HN Senior Editor

H&HN Daily

Blog from HIMSS11



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