A Road Map To Accelerating Health IT Value And Innovation

Health IT is in a state of constant evolution, and it often seems that, for every problem solved, another is created. That’s why it’s vital we stop to assess where the industry stands from time to time, as well as look to the future to determine the best course to take to achieve our collective goals.

Healthcare is enduring a significant period of turbulence and disruption placing increased pressure on providers to become more efficient than ever before. With no letup coming any time soon, health system leaders need to transform their organizations in fairly fundamental ways. Healthcare technology, with its potential to significantly enhance healthcare coordination, efficiency, and patient-centered care, will play a vital role in enabling this transformation and, as such, has tremendous implications for those driving digital transformations at healthcare-focused organizations.

I spoke with Brent Lambert, chief medical information officer, Carolinas HealthCare System; Alan Weiss, chief medical informatics officer — ambulatory, associate vice president, Memorial Hermann Healthcare System; and Sulaiman H. Sulaiman, entrepreneur, accomplished U.S. and international chief information officer, to discuss how to best leverage technology to drive value in the rapidly evolving, post-reform world of healthcare, as well as identify different approaches, capabilities, and key performance indicators that can be used to enhance the effectiveness and value of health IT.

Nothing Of Value Can Be Created Without A Solid Foundation
It would be prudent to, before exploring the future of health IT, take a look at where it is right now. It appears most people have been focusing on Meaningful Use (MU) — or at least they were before word came out this is likely the last year of that particular program. Still, preparing and planning for MU is what put most health systems in the position they are currently in — good or bad.

According to Lambert, MU has been both a blessing and a curse. “There is a list of things we have to do to meet MU, and everybody is very, very busy focusing on that list,” Lambert says. “The question is, are those the right things?” He answers his own question, saying, “Focusing on MU helped get the right infrastructure in place. It was the necessary adoption we needed, but all we’ve done so far is to build the foundation. I think that’s good — we had to do that. But I don’t think that’s all anybody wants. I don’t think that that’s going to bring us maximum value.”

Weiss agrees, adding, “To date, I think we’ve focused on EMRs for the most part — as we should have. Now, if you’re listening to healthcare leaders, you’ll hear Big Data or mobile apps are going to save healthcare. I think we’ve lost perspective. I think most of the doctors out there are struggling to get through the day on their EMRs.”

For his part, Sulaiman agrees the correct health IT base is in place but the speed at which all of this has happened has left us with some cleaning up to do. “Because of how rapidly we’ve gone through this most recent phase, the quality of technological implementations — as well as the adoption and usability of those technologies — are not really where they need to be.

“I want to shift from the implementation phase to the optimization and transformation phases. The e implementation did have some transformation in it but, in reality, the tool itself is not transformation. What’s important is how you apply the tools, change workflows, and reengineer and redesign existing technologies into something that will ultimately add value.”

Where To Begin Should Come As No Surprise
What changes need to be made to accelerate the value of health? The first thing to do is fix the much-maligned EHR, which is still the number-one complaint of physicians. EHRs, which to some extent have become nothing more than an invoicing system, directly impact a physician’s level of efficiency by adding steps and an incredible amount of clicks to their world that did not exist before.

“Physicians hate EHRs, and if I’m asked to do all of the administrative tasks they are doing, I would probably hate them as well,” says Sulaiman. “But we needed that technology and the data that comes with it. Now we have to work to improve them because it’s impossible to manage care today without them.”

Weiss agrees, adding, “The people who are implementing the EHR have to step back and make sure they’re implementing in ways that help providers anticipate where content is and ensure it mirrors a physician’s normal workflow.” He cites as example a Cleveland Clinic EHR project he was part of in which his team updated the preference lists for meds, diagnoses, and labs. None of the existing technology was changed, Weiss’ team simply made it more usable. “You need to work on projects that make the EHR easier to use, and you have to make those easy things so intuitive that providers just do it naturally,” says Weiss. “That’s the hard part.”

Similar techniques helped at Memorial Hermann where the combination of standardized content and provider-friendly forms led to physicians closing their notes five minutes faster, per encounter. It also allowed them to see 65 percent more patients. “We could also objectively show the number of complaints about the EMR dropped in half,” Weiss recalls. “I read all those complaints and the tone became, instead of angry, more collaborative.”

Blame The Vendors! (No, Not Really)
Most providers, when asked who’s responsible for poorly designed EHRs, blame vendors. The e end of MU may provide the break vendors need to catch up to where providers want them to be, but one thing to remember is vendors have given the industry exactly what was asked for.

Lambert says, “We have to understand who the vendors are and what they’re in business to do. They are out there, trying to please their customers, and their customers are asking for many different things.” As a result, vendors are left trying to hit a lowest common denominator across an incredibly wide user base, making no one completely happy.

“That’s the job they have to do and we’re stuck grabbing something off the shelf, doing the best we can with it, and providing lots of feedback to our vendors to try to help them get there,” Lambert says. “But they’re never going to get there as quickly and exactly as you would want them to.”

Weiss agrees vendors are between a rock and a hard place as it’s hard to please everybody and come up with a cohesive solution. “Every state can have different views of certain aspects of EHR use and EMR vendors and responsibilities,” Weiss says. But that doesn’t let vendors off the hook completely. “They’re in a tough spot to create software that works the best,” says Weiss, “but they’ve made some pretty big mistakes in the process.”

There is one solution, albeit a radical one, beyond simply mending the EHR. “I really would love to get rid of the EHR as we know it,” Sulaiman says. “Not shutting it down and starting over, but thinking of innovative ways to capture, store, and manage data in an electronic fashion without asking providers to do more.”

Sulaiman believes there are innovators who could rework EHRs in ways which would allow physicians to do what they do best — deliver care to the patient — and leave managing the administrative tasks of the EHRs in the hands of other experts within the organization. “It’s a paradigm shift,” says Sulaiman. “We should stop asking physicians to tweak the EHR but rather come up with ways to take it out of their hands to capture data differently. We need to allow physicians and other caregivers more time to focus on the patient, to be more efficient, and provide both a better experience and outcome for them and their families. Capturing, clicking, and spending 5, 8, maybe 10 minutes more per patient tackling the EHR are not the way to do it. We need to give that time back. That’s a challenge to me and my peers in HIT [health information technology].”

Taking The Next Steps
Fixing what’s wrong with EHRs is just one of the steps on the path to accelerating health IT value and innovation. With a strong health IT foundation in place, it is time to look to the future and determine what needs to be done to deliver better outcomes.

One area of opportunity is using IT to reduce unnecessary care. “The technology we’ve put in is designed to drive people to our EDs, not to an appropriate setting,” says Lambert. “You look out and people have tied their ED registration system into the billboards on the highway. Advertising ED wait times may be driving dollars to the bottom lines, but I don’t think that’s necessarily driving maximal healthcare value.”

Implementing everything from virtual care to e-business, to care management are ways to improve access and drive maximum value. Health IT is at the core of this, but we are just beginning to scrape the surface.

“If you look at the MU dollars that have been paid out to date, I think that you’ll find they’re far above what anybody ever projected they would be,” says Lambert. “If the program has been administered OK, it means the adoption of healthcare IT has occurred at a faster rate and more completely than anybody ever thought.”

What is difficult is determining if we are heading in the right direction. “I think any time you ask people to make changes there will be resistance,” Lambert says. “That’s what we’ve asked people to do — make changes. I think, overwhelmingly, healthcare providers believe it’s the right thing to do, and they believe the tools we have could be better. But I think that everybody agrees that we need to head in this direction.”

Whatever direction health IT goes, Sulaiman says the challenge is to be creative. “Let’s not simply tweak existing technologies. Let’s be true innovators, transforming and positively changing the delivery of care in ways we’ve never seen before.”

This will require reallocating resources from project mode to optimization mode, something Sulaiman did when at Mission Health System. “I was spending 80 percent of my budget on projects when I started. Toward the end of my time there, we reduced that to around 60 percent and put the difference into optimization.” That strategy will result in true transformation, bring more value, and enable better care, Sulaiman feels.

For his part, Weiss believes IT is helping establish population health and addressing gaps in care, but is concerned we’re headed down pathways he’s not sure are going to help that much — specifically a surge in analytics. “Big Data is about finding new concepts and insight into what’s happening in healthcare. But many organizations say they’re doing Big Data when they’re not.”

To illustrate his point, Weiss recalls a talk given by the CMIO of one health system at a Big Data event. “He talked about how they decided to measure the decibel level in every ICU room in every hospital in their system.” The project lasted a year and generated a large amount of data that was correlated to the vital signs of the patient in the room. It concluded when it was louder in the room, vital signs were more variable.

“What I heard him say was you should be quiet around sick kids,” Weiss said. “To me, this is not what Big Data and analytics are about. They should be about finding new insights.”

The Never Ending Journey
Whatever path health IT takes, ultimately, patients will play an important role in determining it. Patients want what they have in other industries: quick access to data, quick answers to questions, and 24/7 access. One technology fueling patients’ desire for more health data is mobile apps.

“There are more apps out there than you could ever imagine,” says Weiss. “The way apps and mobile devices will be used to allow patients access to providers in concise, easy-to-use ways is what I believe will become the defining aspect of health.”

Healthcare still has to provide the appropriate technology to meet these patient demands, thereby creating better focused care and communication between patients and the caregivers. Doing this the right way will, according to Sulaiman, lead to better implementation of, and results, from population health management.

“Without patient engagement and accountability, population health is going to struggle,” Sulaiman says. “Whether a patient is scheduling regular checkups, managing their blood pressure, managing diabetes — all of those things will require patient engagement.”

“I really, truly believe health IT and the data it creates can be an incredible asset when used right. We need to be thinking about not only getting people well, but keeping them well, and the tools that we have, and the access to that information, and communication, can indeed support that effort.”

One thing to keep in mind as we move forward is that there is no finish line. As we do more with health IT, we’ll actually discover more and more opportunities.

Or, as Lambert said when asked where he thinks health IT innovation will finally end up, “I don’t think it will ever end — we’ll always be chasing it. This is a forever process. One of the things health IT does is illuminate the dark corners in the room. We find problems that have always existed, but we didn’t know existed. That’s a good thing, and I think we’ll be chasing those forever."