I attended the annual conference of the Virginia chapter of HIMSS (Healthcare Information & Management System Society) in Williamsburg this past week. I hoped to both make some good connections, and to hear some ideas and lessons learned from health IT practitioners who had seen first-hand how Electronic Health Record (EHR) deployment worked in the real world.
I succeeded on both counts.
The 2-day session program started with the CEO and CMIO of Sentara Healthcare sharing their experiences in deploying EPIC (EHR) and MyChart (Patient Health Record/PHR). Dave Levin, Sentara’s VP of Medical Informatics, reported that “I feel like I’m practicing at the top of my game” is something he’s hearing from many Sentara doctors and clinicians since EPIC implementation.
Deploying EHR technology is driving a move beyond just analytics to knowledge management – however, Levin says that many primary care physicians will struggle to make the business case for EHR, while specialty practitioners feel that neither the carrot (federal incentive payments) nor the stick (reimbursement reductions for practices who don’t deploy) are big enough to drive EHR adoption.
One of the critical pieces of building a technology-driven healthcare delivery system is the ability to exchange medical records seamlessly across the provider and payor spectrum – each state is building a Health Information Exchange (HIE) in service of HHS’s Nationwide Health Information Network (NHIN). Mike Matthews, CEO of MedVirginia and one of the drivers of the development of Virginia’s HIE, was next on the platform. The process is still underway to build out a state-wide HIE, but Matthews offered some positive news from one large Virginia healthcare provider who saw a $2M increase in Social Security Administration reimbursements after implementing e-health initiatives.
A panel of CMIOs took the stage to offer their EHR deployment war stories – one of them made the observation that “we are all Henry Ford”, meaning that every HIT leader was creating a healthcare version of the first Model T assembly line. Usability is a key issue, and the panel agreed that “good enough” needs to be the first milestone in driving EHR adoption. The ambitious time-line for that adoption, combined with the economics of deploying systems and herding the multiplicity of cats who will use them, makes the case that “good enough” will have be good enough for the initial phase of e-health. They also observed that “meaningful use” has to translate into “better care”, and that payment reform (which in this writer’s opinion is a better name for what’s now being called healthcare reform) must make quality of care the key incentive to higher payments.
Most of the CMIOs on the panel were family practitioners – the front line of healthcare. They all agreed that HIT usability was in conflict with meaningful-use criteria box checking, and there was more than one reference to the need for tort reform to put the reins on “defensive medicine”. A culture of disclosure has to become part of managing risk.
The program continued with input from Dana Moriconi and Leah Wacksman of VCU Health System, HIT expert nurses who have seen the convergence of IT and clinical practice driven by “unit champions”, evangelists for the process who facilitate IT adoption on the front lines of healthcare.
Virginia’s Secretary of Health & Human Services William Hazel, an orthopedic surgeon who has joined the McDonnell administration to help turn statewide health into an economic advantage, was up next. His paradigm for meaningful healthcare reform in Virginia: improved access, increased value of care, rigorous safety protocols, all combined to enhance both patient and physician satisfaction.
The “medical home” is a catch-phrase of the moment for primary care – Dr. Stephen Morgan, the VP of Medical Informatics of Carilion Clinic in Virginia’s Roanoke Valley, presented a case study of Carilion’s development of a patient-centered medical home. Focusing on diabetes, hypertension and asthma, Carilion’s Family Medicine group in Vinton VA achieved one of the 1st Level 3 certified medical homes in the nation. HIT enables much of the connected care that is a hallmark of the patient-centered medical home, helping develop the relationship-based care that increases treatment effectiveness and patient health.
Wrapping up the 1st day’s sessions, VCU’s Professor of Biomedical Informatics, Jonathon DeShazo PhD, talked about “New Last Mile”, using patient health records (PHRs) and patient portals to build deeper connections between healthcare practices and their patients. The challenges for PHRs and portals include authentication – is this really the patient? – and determining what data the patient can access without needing interpretation from a medical expert.
Sessions on the last day of the conference kicked off with an address by Delegate John O’Bannon, a neurologist who is also the representative of Virginia’s 73rd Assembly District. Dr. O’Bannon echoed the call for tort reform first heard in the previous day’s CMIO discussion, and floated the idea that the requirements for employer-based healthcare insurance might lead to the end of health insurance tied to employment, given that the $2,000 per employee penalty for failing to provide coverage to employees was significantly cheaper than the coverage itself.
Mark Blatt, an MD who leads Intel’s global healthcare strategy, presented some interesting conundrums created by the rise of cloud computing in healthcare. The efficiency and agility afforded by cloud services raise significant risks on the security and enterprise support side. Plus, integration and on-going operations can bring unforeseen costs to cloud-deployed platforms. His recommendations included separating data into private/public silos, with the private (clinical data, mission critical applications, ERP) staying on client-controlled servers and the public (billing, knowledge management, hosted web apps) going into the cloud.
Joe Becht of Deloitte & Touche LLP took the podium next to give an overview of the impact of reform on the healthcare revenue cycle. In his view – and I agree – ICD10 will have a huge impact on data management costs for healthcare facilities, from small practices to large systems. Quality will become a payment criteria, and hospitals will become the bank in the blended-payment model of the Accountable Care Organization (ACO).
The outreach director of Virginia’s HIT Regional Extension Center (HITREC), Jann Anderson, gave a report on the effort to help smaller practices, rural clinics, and community health centers across the state implement EHR in their facilities. HITREC, with the help of a federal grant and in collaboration with the Center for Innovative Technology, offers providers help in both selecting EHR technology and navigating meaningful use.
The event wrapped up with a CIO roundtable featuring the IT leaders of Inova, Bon Secours, Valley Health, Riverside/Sentara, UVA Medical Center, and Rockingham Memorial. All the panelists have deployed EHR technology in their organizations and are now navigating meaningful use, how that will drive quality and continuity of care, metrics, data management and security, and reporting.
The central challenge is in defining the criteria and protocols for each part of the system. Tying that to both CPOE and quality measures, pulling data into reports that help drive progress toward better care, and controlling the costs of data management is what these CIOs deal with every day – as one CIO put it, “it’s a full-time job…and then some!”
They all noted that MyChart is driving patient engagement – giving patients their “damn data” (thanks again, e-patient Dave!). On the clinician side, desktop virtualization and QuickTap ID badge login/logout systems are making for both clean platform management and good usability.
iPhone apps and EHR mobile integration, in combination with MyChart, are helping facilitate adoption by clinicians and patients, breaking silos of care.
The next goal: using IT to help move beyond meeting needs to anticipating needs, on both the clinician and patient side. Laudable, and achievable, as long as all the participants hold on to that collaborative vision.
Great conference, with great content and great conversations. Thanks, VA HIMSS – I’ll definitely be at the next one!