Healthcare IT: Is it All Hype?

The topic of health information technology (IT) seems to be popping up everywhere nowadays. No longer the province of healthcare and tech-focused websites, it has recently made prominent appearances in the pages of high-profile, widely read publications like Time magazine, the Boston Globe, and The New York Times, and has been featured numerous times on popular news outlets such as CNN and MSNBC. Once the presidential campaigns start heating up (and yes, they will get much hotter), health IT will likely get even more air time. Given all this massive media exposure and attendant hyperbole, and in light of some of the grandiose claims made regarding the capabilities and promise of healthcare IT, one could be forgiven for asking the question: Is health IT all hype?

One person who certainly doesn’t think so is Kevin Hutchinson, a guy who knows a thing or two about health IT. Hutchinson is an active member of the American Health Information Community (AHIC) and serves as president and CEO of SureScripts, an innovative outfit based in Alexandria, VA, which has made it its mission to “facilitate the electronic transmission of prescription information between physicians and pharmacists” and “improve the overall quality, safety, and efficiency of the prescribing process.”

When Hutchinson moved to Alexandria, VA, three years ago, he had an interesting experience: about 10 minutes after he installed his telephone and fax machine, he started receiving faxes. Tons of them. Only it wasn’t like the Seinfeld episode where Elaine was getting bombarded with restaurant menus. There was nothing comical about what Hutchinson discovered when he began sorting through the laboratory results, prescription refill requests, discharge summary reports, and other crucial medical documents that were being sent to him instead of to physicians’ offices.

After some investigating, Hutchinson learned that the fax number assigned to him was previously registered to a nearby practice. The catch? The physician’s office, it turns out, changed the number three years earlier. The pharmacies that were still using the (supposedly) defunct number had received several notices that the number had changed; however, their speed-dial settings still contained the old number and continued to send prescriptions to a business address and not a doctor. “I couldn’t believe it,” said Hutchinson in an interview with MDNG. “We’re talking three years. It really opened my eyes.”

Take-Home Message

The whole ordeal could have been avoided, said Hutchinson, if ePrescribing systems had been put into practice by the physicians and pharmacists involved. ePrescribing—or as Hutchinson prefers to call it, “the automation of the prescribing process”—works to fix the errors often caused by manual entry while facilitating the “interaction between physicians and pharmacists” that plays such a crucial role in the process. With this technology, healthcare professionals have the potential to reduce the number of adverse drug events that occur and achieve significant improvements in workflow. And of course, there’s the financial issue. One study suggests that adoption of ePrescribing technology could save as much as $27 billion in healthcare costs domestically.

What’s even more promising is that health IT, including ePrescribing, seems to be gaining in popularity among both physicians and patients. Results from a survey announced at the “Health IT: Unlocking the Potential” summit suggest three times as many Americans favor healthcare providers who use electronic medical records (EMRs) over those who do not, and more than four times as many Americans prefer insurance carriers who have entered the digital age. The study, commissioned by Kaiser Permanente, also shows that 72% of American adults view a computer system as more efficient than a paper one when it comes to managing medical records, and—perhaps even more importantly—73% believe that the benefits offered by EMRs outweigh the potential privacy risks.

During an address at the recent Government Health IT conference in Washington, DC, Robert Kolodner, MD, national coordinator for health IT, stated that the quest for health IT adoption has “made more progress in the last three years than we had in the last decade, or maybe two decades,” adding that we are now at “the tipping point.”

In a statement reported on the Healthcare IT News website, Andy Stern, president of Service Employees International Union (SEIU), said that health IT “can transform healthcare for the benefit of those who deliver it and those who need it.” SEIU recently joined forces with two other advocacy organizations, AARP and Business Roundtable, to present a case to Congress for further support of health IT adoption. Not only can health IT serve as a “building block” to healthcare reform, but it can result in significant savings, according to Stern, who cited a 2005 RAND study that estimated the potential efficiency savings at more than $77 billion.

The benefits of health IT adoption extend far beyond just cost savings, however. Innovative thinkers are proposing other ways in which health IT can significantly improve patient care.

• In Maryland, the Community Health Integrated Partnership is working on an initiative to establish an EHR system and integrate it with an existing automated registration, scheduling, and billing system that serves the uninsured.

• In Michigan, urban teenagers using a Web-based asthma program reported fewer symptoms and missed fewer school days than students who were utilizing more traditional methods of monitoring and education.

• Oregon Health & Science University launched a $7 million federally funded pilot project to determine whether monitoring technology can help detect earlier signs of Alzheimer’s disease.

Must Be the Money

With what seems to be overwhelming support from both patients and physicians thanks to the success of selected programs, the potential of forward-thinking initiatives, and projections of future successes, the case for health IT adoption should be a slam-dunk. But not everyone is sold on the idea. Data from two surveys conducted by Health Industry Insights suggest that some physicians feel that incentives are hard to come by and are not necessarily high on the list of concerns for payers. The first survey suggested that a majority of managed care companies are not providing physicians with financial incentives to adopt IT systems that are needed to track quality health data for pay-for-performance (P4P) initiatives. Only 37% of payers surveyed reported offering physicians financial incentives to deploy IT systems, despite the fact that “IT systems, including electronic health records and electronic access to clinical guidelines, are the most effective ways to collect and track the patient data.”

The second survey suggested that “many payers don’t actively invest in or sponsor physician IT adoption and many more don’t incorporate it as a P4P incentive,” and that “despite the industry standard that physician IT adoption is critical to better outcomes, payers ranked it fifth in a list of seven factors required for successful P4P programs.”

Fortunately, there are some groups and organizations that rank health IT adoption much higher among their priorities. The National ePrescribing Patient Safety Initiative (NEPSI), a national program launched earlier this year in response to the staggering number of medical errors that plague the healthcare system, provides US physicians with free, Web-based electronic prescribing software. The goal of NEPSI is to facilitate the use of ePrescribing software by every physician’s office and pharmacy in the US, and, subsequently, eliminate thousands of injuries and deaths caused by prescription errors.

Physicians who are reluctant to send records electronically to healthcare providers in other states for fear of breaking privacy laws can take comfort in the fact that the State Alliance for e-Health likely will develop legislative language to provide healthcare professionals safe harbor from violating state laws. “The alliance’s Health Information Protection Task Force recommended that the group develop language as part of an initiative to increase the electronic transmission of patient information between providers in different states,” according to Government Health IT.

It’s a Poor Musician Who Blames His Instrument

Physicians who mistrust the reliability and effectiveness of current technologies and physicians who are uncertain of their abilities to successfully implement new technology are major barriers to health IT adoption. Because of these and other reasons, many physicians still haven’t fully embraced the health IT revolution. According to Hutchinson, some instances aren't so much a refusal to integrate as much as a lack of education on how to best navigate certain systems. “A lot of the time, it’s a problem of awareness,” said Hutchinson. “A lot of physicians out there are filing electronically, but then they’re still faxing ePrescribing orders.” In some cases, physicians simply have not been educated on the correct way to navigate the technology in order to achieve optimal results.

To that end, the Centers for Medicare and Medicaid Services (CMS) is doing its part to assist physicians in the adoption and implementation of EHRs and care management practices with the launch of the Doctor’s Office Quality IT University website. A free education tool designed to help small-to-medium-sized physician practices adopt health IT, the program provides self-paced lessons and tools for the adoption of EHRs and care management practices.

Where Do We Go?

Steve Lieber, president and CEO of the Healthcare Information and Management Systems Society (HIMSS), reiterated Hutchinson’s sentiments when discussing the results of a survey in an interview with iHealthbeat.org. “The focus now is on technologies that help practitioners do their job more effectively, more efficiently,” said Leiber, who also expressed that health IT dialogue has become more “focused” and “tactical,” shifting from “discussions of what we might be able to do” to “things we must do.”

Similarly, in a keynote address given at HIMSS in February 2007, Tennessee Governor Phil Bredesen, an avid supporter of health IT, said that in order to experience success, “we have to move beyond this tinkering around the edges approach of grants and pilots, make some choices, simplify our focus, and move ahead.” Governor Bredesen has earned a great deal of praise for his efforts, which include the 2004 launch of the Volunteer eHealth Initiative, a pilot project created to improve the delivery of healthcare in Southwest Tennessee and help lay the groundwork for better care statewide.

The Volunteer eHealth Initiative “has truly catalyzed the healthcare delivery community to focus on health needs,” according to David Archer, Chairman of the Board for the MidSouth eHealth Alliance. “Secure and confidential exchange of health information will provide our patients with better care by ensuring both better continuity of care and sparing them the risk and discomfort of unnecessary tests and procedures. More information, given to healthcare clinicians with the consent of their patients, will lead to better care.”

Given all the pilot programs, working groups, position statements, professional coalitions, vendor initiatives, federal legislation, and myriad other efforts, pronouncements, and projects focused on promoting more widespread adoption of healthcare IT, it would seem we truly are at a “tipping point,” as Kolodner expressed. Interest in health IT—among healthcare professionals and patients—is clearly there, the necessary resources are becoming available, systems are being put into place, and the kinks are being worked out. From where we stand now, it appears that health IT just might get a chance to fulfill its immense promise.

Believe the hype.

Which States Have Been Active Lately in Health IT Initiatives?

CALIFORNIA

Hewlett-Packard Co. agreed to help develop a California health information exchange to give physicians, hospitals, and patients access to secure electronic medical information.

More than half of the California physicians involved in a year-old pay-for-performance (P4P) consortium have reported using new healthcare IT to schedule patient visits and appointment reminders. City of Hope, a cancer center in Duarte, CA, announced it will roll out a computerized physician order entry (CPOE) system to help care and reduce costs.

Physicians participating in a P4P initiative launched by Cisco, Intel, and Oracle report greater use of EHRs, ePrescribing, and online appointment scheduling systems.

MARYLAND

Arnot Ogden Medical Center announced it will use the software it received through a grant program to create an EHR for patients who seek treatment from any physician affi liated with the medical center.

Maryland’s Community Health Integrated Partnership is implementing a $2.9 million effort to computerize paper medical records and integrate them into an existing automated registration, scheduling, and billing system.

MASSACHUSETTS

Brockton Hospital’s Physician Hospital Organization awarded an $89,000 grant from Harvard Pilgrim Health Care to fund an EHR management system for cardiac and diabetic patients.

NEW JERSEY

Two hospitals adopted a wireless system to share access to computing systems and servers.

OHIO

Patients can now use Mount Carmel Health System’s website to pay bills online, and the health system plans to add online scheduling and e-mail reminders for patients.

TENNESSEE

Rural, mid-size, multi-specialty practice Holston Medical Group in Kingsport, TN, convinced physicians to invest in ePrescribing by first offering the software to nurses. The company is now saving $50,000 a year just by doing electronic refills.

VIRGINIA

The Department of Veteran Affairs could earn an increase of $6.6 billion in healthcare funding in the fiscal 2008 budget resolution to help it fi x gaps in healthcare facilities and treatment.

WASHINGTON

At Virginia Mason Medical Center in Seattle, WA, business-process redesign experts from Toyota Motor Co. actually helped the large, hospital-centric group practice change its antiquated workfl ow to accommodate CPOE.