There are many projects which need to happen in order to make HITECH work. From implementing an or CPOE system to building an effective electronic patient information exchange to delivering electronic reporting capabilities, the scope of work is tremendous, and it all depends on health IT.

Do you agree? There may be a few people who differ with that assertion. Physicians, clinicians, and patients will all be users of these systems, so Meaningful Use success will be based on their adoption and daily interaction with specific applications.

 

The debate: Is the driver of achieving HITECH's objectives health IT or health IT users?

 

View 1:

Health IT professionals and systems will make work

It's Time for Technology: Technology has always been prevalent in healthcare, but it has not been used as much in consolidating patient information, providing electronic access to individual patients, or reporting certain quality metrics. Today, we do not think twice about going to any ATM machine in the world and being able to gain instant access to our money. Similarly, we do not think twice about logging into the web to access various financial accounts, make transactions or conduct research on different services.

The time has come to implement and leverage technology, in a similar way, to healthcare. The only way it can happen is by employing good technology with a vision of access and distribution.

Technology Equals Enablement: Information technology is the enabler. Just as technology has enabled the financial industry, it can do the same for healthcare. There were certainly visionaries and modern technologies that led the way to mass adoption. In the end, however, it was up to the proper selection and implementation of innovative yet robust software and hardware to make it happen.

In today's world, with HITECH and Meaningful Use, it is not optional any longer. John Glaser emphasizes this point in a Hospitals & Health Networks article: "The increasing demands for accountability for the cost, quality and safety of care cannot be met through systems and processes based on paper. The federal and state incentives and penalty programs, which may be paralleled or leveraged by private payers, make the absence of an EHR an increasingly problematic financial issue." (A New Era in IT's Strategic Importance)

IT can make healthcare workflows work. With the right technology in place, users will come and use it to their benefit. Change will take place, but only after the technology is pervasive throughout most care delivery organizations.

Proper Implementation Depends on IT: Without the technology, we are back to paper, continuing inefficiencies and islands of patient information. Waiting for physician acceptance or changes in workflows will only erect more hurdles and prevent making any advancement in the way patient care is delivered. Yes, it is people, technology, and process coming together which will deliver success in most initiatives. In the case of achieving the HITECH objectives, technology needs to take the lead and bring the other two along.

View 2:

Health IT users – physicians, clinicians, and patients – will make HITECH work

It's About Relationships: Physicians and clinicians develop the relationships with patients, build the trust, and understand the level of care required in various situations. Technology can sometimes get in the way of the primary mission. Interacting and focusing on the patient is more important than trying to enter data into a computer.

EMRs and EHRs can play a role, but they need to be implemented with the patient in mind, not just for technology's sake.

This point is illustrated by John Moore in The Health Care Blog when relating an experience he had while visiting a Vermont primary care/pediatrics clinic. The clinic installed an EHR and here is summary of the result: "Productivity is way down, countless glitches have occurred, whole system crashed during a recent upgrade and the list goes on. For 2009, this clinic, which has been in operation for a few decades, had its first ever loss last year, the year they went live with this EHR. The clinic puts the blame squarely on the EHR, which has severely constricted their ability to see patients and as all readers know, clinicians get paid for seeing patients, not trying to use a complex and difficult to use EHR." (It's Not About Meaningful Use …)

It's About Workflow and Operations: Workflow should drive technology decisions and implementations, not the other way around. Physicians, clinicians, and patients etc. are who will drive what will get used and what won't. There is no secret to the fact that poor workflow analysis leads to failed IT projects, and it also can be said that taking a cookie-cutter, one-size-fits-all approach to healthcare workflows just will not work.

The HITECH implementation benchmarks need to be slowed down in order to get the workflows right first and then apply technology in reasonable way. Right now, HITECH benchmarks are designed on implementing technology, not matching it to care delivery processes. Lowering initial HITECH hurdles or stages will give healthcare organizations time to increase its chance of success.

Usability and Care: It's just another Y2K effort – lots of dollars and little to show afterwards. This seems to be the path HITECH is currently on. Application usability needs to be evaluated properly as well as its potential impact on the delivery of care.

As David Muntz, Senior Vice President and CIO, Baylor Healthcare System, communicated when testifying before one of the Federal workgroups:

"The successful implementation of an EHR is the result of many complex, coordinated activities. These include new technology, new processes and new behaviors on the part of clinical staff."

"…To transform clinical care through the use of enabling technology 'does not happen without process redesign and change management support, training, rehearsals, strong leadership and coaching to support the paradigm shift that each caregiver must experience,' Muntz added." (CMIO.com, CIOs testify against meaningful use time crunch to federal panel)

To make HITECH work, the physicians, clinicians, and patients need to be intensely involved in the process so changes will occur in a practical, high quality manner. Patient care and usable systems must be placed as a priority in the implementation process.

Both points of view are reasonable perspectives to consider. For this debate, the key summary points as we move forward may be:

  • IT is a strategic imperative across the healthcare spectrum. Healthcare information technology needs to be an essential enabler to enhance quality of patient care, increase workflow and operational efficiencies, and broaden secure access to patient data.
  • There is a risk of implementation fatigue and momentum loss. Many healthcare trade organizations have provided comments on the Meaningful Use NPRM and the Healthcare Standards IFR, with a unified chorus stating the proposed rules are asking for too big of an initial leap. The Stage 1 hurdle may need to be lowered in order to get projects started on the right path. Without early successes, implementation fatigue may set in, and the achievement of the HITECH goals will begin to slide.
  • A balanced approach is required to reach the HITECH objectives. Balance translates into a practical implementation approach which weighs considerations and impacts on workflow, people's interaction with technology, and the applications and supporting technology itself. The three need to work together in a synchronized way.

 

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