The Promise of Health IT

On Friday January 11, both the New York Times and the Washington Post cited a new Health Affairs commentary from RAND researchers, “What It Will Take To Achieve The As-Yet-Unfulfilled Promises of Health Information Technology.”

The press coverage focused on the “as yet unfulfilled” portion of the analysis.  I want to share my support for the important work that RAND has undertaken and express appreciation for RAND’s continued focus on this nationally-pivotal topic.  A transformation across a nation is hard work, complex, and not for the faint of heart.  We are in such a transformational time period; RAND’s commentary provides crucial insights to help us all on our journey to the goal – to use IT in such a way to enable us to retain or regain our health. . .without breaking the bank.

I wanted to share some of the evidence we have at HIMSS of how – in providers’ offices, clinics, and hospitals around the country – health IT is being used towards this goal.  In fact, my post serves as the first in a series on the HIMSS Blog, with insights from the HIMSS Davies Award on the value of health IT.

I’ve blogged in the past about the return on investment (ROI) of health IT, pointing out how difficult it can be to measure ROI in healthcare.  Last Fall, I wrote that “a true measure of ROI must include the full spectrum of benefits that can result from a successful IT implementation: improved patient safety, improved quality of the care provided, improved relationships with patients, streamlined internal processes, innovation, and other qualitative factors.”  Those factors are difficult to measure, but incredibly important.

While the widespread implementation of health IT may not be happening as quickly or as efficiently as we’d like, it is happening.

Just today, HIMSS Analytics released new data showing that “in the five most recent quarters for which data is available, beginning with the first incentive payments from the Medicare and Medicaid Incentive Program in 2011, U.S. acute care hospitals achieving EMRAM Stage 5 or Stage 6 have increased by more than 80 percent; Stage 7 has increased 63 percent. We are seeing declines in the percent of hospitals that are only at Stages 0, 1, 2, and 3.” See graph below.  The data show that meaningful use is contributing to its intended result of increased implementation of EHRs.

HIMSS Analytics chart

This graph shows sharp increases in the percentage of U.S. civilian hospitals achieving HIMSS Analytics’ EMRAM Stages 5-6-7 beginning with the first Medicare meaningful use incentive payments in May 2011, through September 2012. During the same time period, the percentage of hospitals in Stages 0-1-2 showed significant declines. These statistics suggest increased implementation of electronic health records over the past five quarters. For more information visit HIMSSAnalytics.com/EMRAM.

What does this mean?  Allow me to explain.  There are a little over 5,000 civilian-based hospitals in the United States.  Using data from a survey of virtually all of these hospitals, HIMSS Analytics has figured out that hospitals are becoming increasingly sophisticated and mature in their use of health IT.  It means that more and more hospitals are routinely able to check for drug-to-drug interactions – before witnessing the effects in a patient.  It means that fewer patients are suffering from bad outcomes due to illegible handwriting scrawled on a prescription pad.  It means that more children get their immunizations because their pediatricians can – with the click of a button – print out postcards that are sent to parents.

As HIMSS Analytics points out, hospitals that are moving to the higher stages of EMRAM “are laying the groundwork for interoperability to occur.”

An increasing number of vendors and health care organizations are focused on achieving interoperability that will support information exchange. For example, over 100 health IT companies and research organizations will participate in January’s IHE North American Connectathon, testing more than 130 health IT systems for cross-vendor information exchange. And, for the first time this year, 21 health IT companies will test the interoperability of transitions of care using the HL7 Implementation Guide for CDA® Release 2: IHE Health Story Consolidation, as recently adopted in the Meaningful Use Stage 2 Standards and Certification Criteria Final Rule.

How is all of this interoperability stuff helping to achieve the promise? Progress is made as the vendors who make IT hardware & software get together annually in a neutral setting to literally hook up computers with each other to ensure that clinical information can be transmitted securely from system to system to system.  That then enables “Dr. Jones” to electronically and securely share a patient’s information from his/her medical record when that patient is admitted to the hospital.

Or, when a wounded warrior comes home from Iraq or Afghanistan, the local hospital can securely share the warrior’s medical information with military and veterans hospitals when caring for him or her.

We are moving in the right direction.  It’s taking time, and it requires everyone’s hard work and commitment. HIMSS will continue to do its part to assist our members in fulfilling the promise of health IT to improve patient care in the U.S.

What are your biggest challenges in achieving the promises of health IT?  What are some resources that you’d like HIMSS to provide to help you on the road to meaningful use?  What stories can you tell us about the value of health IT?

About Carla M Smith, MA, CNM, FHIMSS

Carla M Smith, MA, CNM, FHIMSS , is HIMSS Executive Vice President.
This entry was posted in Health IT News and Developments, HIMSS News and Developments, Interoperability & Standards, Patient-Centered Systems, Value of Health IT and tagged , , , , , , , , , , , . Bookmark the permalink.

11 Responses to The Promise of Health IT

  1. Willa says:

    Yes, the Rand study presents objective evidence that adoption of electronic health records and health IT has not achieved the results they predicted in 2005. The Rand authors provided a thoughtful explanations for these disappointing results: the United States has had a sluggish adoption of health IT (thank you HITECH Act for providing financial incentives to accelerate EHR adoption), the choice of available systems is not particularly interoperable or easy to use (thank you ONC for including interoperability and usability in certification and meaningful use criteria), and users of these systems have not necessarily re-engineered their care processes (ouch, we are learning to not digitize faulty processes, but we all know how hard it is to change how we do things). The NY Times and Washington Post articles sensationalized the results of the Rand report. The Rand report, and others like it, ask important questions, with strong evidence on what needs to be done so we can realize the promises made. And thank you Carla, for writing a well thought out response based on evidence. These next few years will continue to be challenging ones for health IT professionals, as we struggle to improve our electronic systems and care processes to ultimately improve the health of the American public – which I believe has repeatedly been stated as the ultimate goal of the HITECH Act.

    • Carla M Smith, MA, CNM, FHIMSS says:

      Thank you for your post, Willa. I appreciate that you’ve raised the challenge surrounding re-engineering care processes. It reminds me of the saying “paving the cow paths”. A successful implementation of health IT is a collaborative endeavor in which the team who will be using the proposed system are thoroughly involved and committed. This team can look at existing processes and re-imagine them. On HIMSS.org, we have many case studies freely available on our website to help folks learn how others have re-imagined and re-engineered their processes to take better advantage of the health IT systems being purchased.

      • So it would seem that we used tax payer dollars to fund a health care industry, non-profit and for profit, process reengineering program. One would think that the expense of this should have been born by the corporations themselves.

  2. The problem we all have with the current approach is that patient safety and security along with interoperability are still not achievable even though we have invested billions, i.e., given that EHR may work for a vertically integrated environment? The problem is this: we haven’t made significant progress in deriving value at least cost, and we started this journey over 10 years ago, i.e., when by executive order President Bush requested that all HIT be interoperable within 10 years.

    • Carla M Smith, MA, CNM, FHIMSS says:

      I am glad you brought up integration, Sabatini. It’s such an important component. We can achieve interoperability until each health setting tackles the challenge of internal integration of existing systems. I can recall a statement several years ago that still rings true – I was in a meeting about interoperability, and the CEO of a health system walked up to the mic and asked “I’ve been listening to this conversation about interoperability. Can someone tell me when the challenge of integration was solved? Was I asleep?”

      As the HIMSS Analytics EMRAM data shows (see above), civilian hospitals are making strides in integration. And, to provide some additional background, HIMSS Analytics also tracks the use of health IT by more than 25,000 tethered ambulatory clinics. Tethered, in this context, means an ambulatory clinic owned, managed, or otherwise aligned with a hospital or health system.

  3. Deborah Wells says:

    We can’t expect to catch up on dozens of years of HIT neglect in just a few. I agree MU has done a fantastic job of moving our health care industry into the digital age. As CMS has said, getting technology in place is the first step.
    I think that getting people to use the technology “meaningfully” is going to be a bigger challenge. Current clinical and administrative work flows are “optimized” to work in a fundamentally siloed, paper system. Unfortunately, it may be that in many organizations the first step toward using technology will be to automate existing processes, as Carla points out. How many times in the history of computing has that played out over and over? The trick will be to keep people from giving up when technology *seems* to make things worse rather than better in terms of provider efficiency.
    I, like Willa, am pleased that ONC has taken an aggressive stand on the use of standards and on interoperability. For the most part, force-feeding seems to be the only thing that will get vendors to include interoperabily with other vendors’ products in their own functionality.

    • Carla M Smith, MA, CNM, FHIMSS says:

      Well said, Deborah. We can’t catch up in a couple of years. But, we are making progress. One conversation I hear repeated over and over is “The banking industry has achieved free-flowing, secure exchange of financial data. What’s taking healthcare so long?”

      In fact, I heard that question raised so many times, I decided to figure it out. What I learned is that – from the date that the first computer was installed in a bank until ATMs became commonplace was a span of 54 years. 54 years – and that was to achieve the electronic transfer, storage, access, and analytics around ones and zeros.

  4. Carla, I was a lead on the Bell Atlantic Transformation Team, responsible for the reengineering of 36 out of hundreds of delivery processes, at Bell Atlantic. This work transformed Bell Atlantic. They eventually became Verizon. The transformation team had 45 consultants and countless numbers of Bell Atlantic employees. We worked for 1 year on the project. Bell Atlantic paid for the transformation project and the implementation of the recommendations. All while Bell Atlantic was, integrating state focused operating companies and converting front office, back office and infrastructure management systems. You never lost dial tone during the transformation. I cannot make the same quality statement regarding interoperability, patient safety or security after 10 years. Amazing, Bell Atlantic accomplished all of this, divestiture had happened, user usage costs controlled, and they accomplished a modernization of delivery systems was accomplished. The industry went though transformation from black phones to the integration of computing and telecommunications, I believe, within a period of 10 years.

  5. I just read an interesting related blog post titled “Has the EHR Bubble Burst” at http://www.hitechanswers.net/has-the-ehr-bubble-burst/?goback=%2Egde_1807798_member_209632309.

    My experience over the past couple of year in Federal health IT workgroups made it very clear that EHRs must evolve to become very useful tools able to drive continuous improvements in care quality and efficiency. This evolution requires a paradigm shift in how EHRs manage, share and present health information. The paradigm shift, I contend, should be from sole reliance on database tables to the integration of those tables with “companion applications” (interface engines, middleware, “bolt-on” tools) that together create next-generation “EHR system.”

    We’ve been advocating the integration of databases with novel spreadsheet applications and have demonstrated how this can raise the bar of EHR capabilities and usefulness to unimaginable levels.

    So, I wouldn’t necessarily say that the EHR “bubble is busting,” but rather that EHR evolution is ripe for the adoption of creative/disruptive innovation or else its true potential will never be realized (and the bubble will burst). Federal money should, therefore, move toward supporting low-cost highly-capable innovations that significantly increase the value of today’s EHRs.

    • Carla M Smith, MA, CNM, FHIMSS says:

      Appreciate your comments, Stephen. There is federal money being spent on innovation via the Affordable Care Act. Under Congress’s direction, CMS set up an Innovation Center to explore new payment and delivery models; IT is an inherent component of this undertaking. And, CMS has also just recently brought on the non-profit FFRDC – MITRE – to positively transform the agency.

      • Thanks Carla. I suggest that we need truly disruptive innovations in the health IT space that turns the conventional paradigm on its head and presents new technologies that challenge the status quo and overcome all resistance in order to make great leaps in usability, functionality, and usefulness. Most of what I seen thus far can be described as “sustaining innovations,” which continuous, evolutionary, incremental.

        What we need, in contrast, are technologically straightforward tools consisting of off-the-shelf components put together in a product architecture with unique capabilities that are simpler, more convenient, and less expensive than prior approaches.

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