By Matthew Weinstock | Data By Suzanna Hoppszallern for H&HN Magazine
Many of the nation’s hospitals and health systems have made progress laying the building blocks for creating robust clinical information technology systems. Now comes the heavy lifting as they look to connect the care continuum, protect patient records in an increasingly mobile world and turn all of those bits and bytes of data they are collecting into actionable information.
As evidenced in Hospitals & Health Networks‘ 15th annual Health Care’s Most Wired Survey, a good percentage of hospitals and health systems have deployed technologies that improve patient documentation, advance clinical decision support and evidence-based protocols, reduce the likelihood of medication errors, and rapidly restore access to data in the case of a disaster or outage.
That wasn’t always the case, even as recently as 2007 when just 58 percent of Most Wired hospitals had systems capable of producing real-time alerts on drug-to-drug interactions. Fast forward six years and 100 percent of Most Wired hospitals now possess that capability, a major step in improving patient safety by reducing the likelihood of medication errors. Going back even further, in 2004, only 27 percent of physician medication orders at Most Wired hospitals were done electronically. That number is now up to 69 percent and climbing.
What’s driving these improvements? Federal regulation for starters. The Health Information Technology for Economic and Clinical Health Act of 2009, more commonly referred to as HITECH, mandates that hospitals and physicians not just adopt health IT, but use it in a meaningful way.
“Meaningful use put technology in front of everyone,” says Linda Reed, R.N., chief information officer and vice president of behavioral and integrative medicine at Atlantic Health System, Morristown, N.J. “But meaningful use is just the base.”
Another key driver: delivery system transformation. Leaders at forward-thinking organizations know they can’t make the leap to such things as population health management or accountable care without fully integrating their operational and IT strategies.
“IT plays a central and pivotal role in the successful transition to value-based payment models,” says David Graham, M.D., senior vice president, CIO and chief medical information officer, Memorial Medical Center and Abraham Lincoln Memorial Hospital, Springfield, Ill. “IT is the infrastructure that enables all clinical and business units to translate data into information and to utilize that information as knowledge for improvement in the delivery of safe, high-quality patient care. IT provides the tools to collect and normalize data across owned affiliates and independent clinical partners.”
Connecting the dots
To get to the next level of care delivery, clinicians, regardless of where they practice, need to be able to tap into systems that provide real-time and real-good information. Yet, significant hurdles remain.
Part of the challenge is resource capacity, says Chantal Worzala, director of policy at the American Hospital Association. A large segment of the field is still resource-challenged and can’t move as quickly as it would like. There is also the lingering question of vendor readiness. The timeline between publication of federal rules governing what vendors must include in their products and when hospitals need to comply with meaningful use Stage 2 is tight and doesn’t leave a lot of breathing room for anyone, she argues.
Those constraints don’t minimize the need to push forward in many areas, not the least of which is connecting the care continuum. Meaningful use regulations increasingly call on hospitals and physicians to exchange health information electronically. Additionally, payment reforms focused on outcomes will necessitate better linkages between the disparate systems in use by hospitals and physicians. Yet, this is an area where the Most Wired Survey shows room for improvement. For instance, 81 percent of the Most Wired organizations report making clinical documentation available in employed physician offices, compared with 74 percent of all respondents. The problem is more severe when looking at independent practices, even for Most Wired hospitals. There, 51 percent of the Most Wired make clinical documentation available electronically compared with just 43 percent of all respondents. Now, consider medication lists and history. Just 40 percent of the Most Wired and 24 percent of all respondents can share that information electronically with nonaffiliated hospitals. Diagnostic images? Only 48 percent of the Most Wired and 31 percent of all respondents can get those to nonaffiliated hospitals electronically.
The long-sought Holy Grail of interoperability is one solution, but the industry has been moving slowly in that direction. Last March, five major IT vendors — Allscripts, Athenahealth, Cerner, McKesson and Greenway Medical Technologies — formed an alliance that promises greater data exchange. It will take time, however, for the CommonWell Health Alliance to get footing. And there’s also the question of what happens to vendors, large and small, not involved in the alliance.
Health information exchanges often are touted as a utility that can better connect care settings. While there are some success stories, there also have been a lot of fits and starts. Sustainability has long been a problem for these types of organizations, dating back decades to community health information networks and regional health information organizations.
“The concept of health information exchange is absolutely correct,” says Russell Branzell, president and CEO of the College of Healthcare Information Management Executives. But, he says, exchanges have been allowed to form without agreement on a national set of standards and data needs. Consider something as innocuous as the way patients enter their birth dates or phone numbers. Some systems use dashes, some don’t.
“All of those things are needed to match you to the record, never mind the clinical data behind it, which hasn’t been standardized,” he says. “We need to standardize the entire process, which we’ve done in almost every other business sector.”
Once exchange is mastered, something has to be done with the data. “Data are not the same as information,” says Richard Schreiber, CMIO, Holy Spirit Hospital, Camp Hill, Pa. “Information depends on analysis and interpretation of measurements of the data. Without measurement, there can’t be assessment of quality, risk, outcomes or value.”
How hospitals and health systems are building support systems for clinical analytics is a new area of study for the Most Wired Survey, and one that seems to have a lot of traction. In research questions added this year, 92 percent of the Most Wired and 81 percent of all respondents said their organizations have an executive sponsor of clinical analytics projects. Eighty percent of the Most Wired have an enterprise-level governance structure in place for clinical analytics, compared with 67 percent of all respondents.
Still, Rose Higgins, vice president of strategic solutions at Relay Health, a business unit of McKesson Corp., a sponsor of the Most Wired Survey, believes there is a disconnect in the understanding of what data are going to be required as hospitals, insurers and others forge new partnerships.
“People have to rethink what they’re investing in. They’re not only going to need enterprisewide data, but also data from outside their four walls,” she says. “As you peel the onion back, you realize that the investments are not where they need to be.”
The AHA’s Worzala adds that clinical analytics will be driven by the business needs of the organization; whether it is building an accountable care organization or taking on risk in another way. Those operational factors will vary from market to market, she says, and drive how clinical analytics is done.
Patient engagement is another burgeoning area in health IT and one in which hospitals have some room to grow. According to this year’s survey, 64 percent of Most Wired hospitals have either a pilot or fully rolled-out personal health record program. Additionally, a low percentage of hospitals — both Most Wired and all respondents — are able to provide patients with electronic copies of their discharge instructions or general health information through a patient portal. In both categories, the most common means of delivering the information electronically was via CD — 67 and 74 percent, respectively.
“The bottom line is that care must be connected and continue wherever the patient is — whether that’s in the hospital or the doctor’s office or in the home,” says Geeta Nayyar, M.D., chief medical information officer at AT&T, a survey sponsor. “The health care industry has lagged behind other industries, such as banking and travel, in tapping technology that can engage the patient and connect the continuum. We are finally seeing real progress as an industry, but there is still more to do.”
Atlantic Health’s Reed agrees. To retain and capture new market share, hospitals have to engage patients on their terms, not the other way around. Beyond making records easily available to patients, Atlantic Health has embraced an ambitious social media strategy that includes everything from blogs, Twitter, Facebook and LinkedIn to a mobile app. Social media is used to deliver care management messages, conduct chats with physicians, and for crisis communications, among other things.
“The systems we are building aren’t for the 85-year-olds of today,” she says. “How are we going to attract patients of the future? It is through mobility and in the different ways we engage them.”