Friday, May 22, 2009

HIT as a Catalyst to Healthcare Improvement

The Center for American Progress - a think tank group dedicated to improving the US through policy and innovation) published a report: "A Historic Opportunity - Wedding the Health Information Technology to Care Delivery Innovation and Provider Payment Reform". You can download the executive summery here (pdf) or the full report here (pdf)

They make the point tat the American Recovery and Reinvestment Act’s HITECH $19 billion investment is not just about technology. In fact if this is the way the program is actioned:
failure is effectively guaranteed if the HITECH program embraces technology adoption for the sake of adoption. But if this new health IT investment program is wedded to a strong commitment to provider payment reform in forthcoming health care reform legislation and implemented specifically as an accelerator of health care delivery innovation and payment reform, then the investment program can help transform U.S. health care as we know it.
We know technology can contribute significantly to our lives. Everything from basic tools in our homes from cell phones to computer access that replaces the limited access to the Encyclopedia Britannica that we had some years back based on the sale to individual homes. This has been replaced for school children and households with access online to all this information in an instant.

Technology has had similar extended effects in healthcare that have seen revolutions in the diagnosis and treatment that previously were unimagined. But technology alone will not solve the underlying problems of our healthcare system and in the US we must change the payment model that currently incentivises everyone int he system to "do more". The system rewards for volume of service delivered and this is the underlying challenge faced by clinicians and facilities that continue to strive to maintain income when presented with the decreasing reimbursement per unit are forced to increase volume. This leads to the current circumstance where a consultation and patient interaction must be limited to minutes if the number of patients to be seen is to increase and the income stream to be maintained.

But seeing more patients for less time does not help manage chronic conditions, allow for a focus on prevention and chronic condition management that demands time and attention to detail. So as they suggest health care reform should include:
  • Proactive improvements in individual and population health status
  • Collaboration among health care providers necessary to accomplish these improvements
  • Achievement of efficiencies in care, such as the elimination of duplicate services, avoidable hospital readmissions, and unnecessary in-person visits
and should also include a change in the documentation and in particular coding requirements. As they rightly point out the current system of coding
so called evaluation-and-management, or E&M, coding of office visits—which drives extraordinary complexity into clinical documentation and EHR workflow—could be replaced by payment-and-documentation standards that are simpler and more focused on what is actually valuable for patient care.
The much used term "meaningful use" comes up again and the suggestion that this be focused on Health IT that actually helps improve care and accelerate payment reform. IN fact the suggestions include:
  • Tracking key patient-level clinical information in order to give health care providers clear visibility into the health status of their patient populations
  • Applying clinical decision support designed by health care providers to help improve adherence to evidence-based best practices
  • Executing electronic health care transactions (prescriptions, receipt of drug formulary information, eligibility checking, lab results, basic patient summary data exchange) with key stakeholders
  • Reporting a focused set of meaningful care outcomes and evidence-based process metrics (for example, the percentage of patients with hypertension whose blood pressure is under control), which will be required by virtually any conceivable new value-based payment regimes.
And in each of these is the implied requirement to capture this information at the point of care which has been a significant challenge to date. I've said it before and I'll say it again - turning our clinicians into data entry clerks does not make sense. Whatever systems are put in place must allow for the capture of this information in way that does not interfere with the patient/clinicians interaction and includes the ability to capture the detail and the data to drive these activities of tracking, clinical decision support and evidence based metrics. There does not seem to be many technologies that can fulfill this at the time of care delivery and one that shines out constantly is that of speech and in particular speech understanding that is able to understand the meaning and generate meaningful clinical documents that can be used in these clinical systems to help deliver this higher quality care.

To this commentator, speech technology and in particular speech understanding must be a fundamental component of the success of healthcare IT as part of the HITECH investment act. What do you think - are we there yet?

Thursday, May 14, 2009

Meaningful Use - Getting the Full Story

There has been much activity relating to the term meaningful use cited in the health care reform proposals form the government that includes AMDIS that includes a new web site to encourage "meaningful" discussion (the website: and various others.

The Healthstory project is carrying the torch for the inclusion of narrative in a written response: Written Testimony Regarding “Meaningful Use” (Word document). Narrative and free expression has been under fire for some years as inefficient and requiring replacement with semantically interoperable information. But since the vast majority (by Gartners estimates 60%) of content is created using the traditional dictation and transcription methodology we fail to leverage this information by discounting it. Trying to force a behavior that is not natural and removes much of the value contained in the fine detail in our rich and expressive language is counter intuitive.
Meaningful use of the Certified Electronic Health Record (EHR) must encompass dictation for creation and exchange of standards-based clinical documentation. This comprehensive view of the EHR supports the immediate needs of front-line physicians and patients, is complementary with structured data, and lays the ground work for increasing EHR adoption and information reuse
Narrative documentation enhances clinical care and the use of free form narrative is essential to the delivery of high quality care ensuring that the care team get the full story and all the fine details necessary to contribute to high quality health care

The Healthstory format - CDA for CDT or Clinical Document Architecture for Common Document Types (CDA4CDT) uses HL7 Clinical Document Architecture (CDA) documents that are XML representations of familiar clinical documents designed for exchange, recognized by ISO, ANSI, NCVHS, CHI, HITSP, CCHIT.

Healthstory represents disruptive technology that has the greatest capacity to transform practice and deliver the benefits of standardization of dictated notes. This is an achievable step for providers that will inject massive amounts of important information into our fledgling networks, lower costs, and provide a clear pathway towards standardized computable data.

Get on board - join now and start insisting on getting the Full Story from your provider, hospital, vendor.....

Interoperability - Smorgasboard of Particpants

Whew - if you want a visual representation of the challenges in the field of government this post in Ross Martin's blog which includes a brilliantly put together harmony you can watch here:

The blog features more details on Health Information Technology Standards Panel (HITSP), Certification Commission for Healthcare Information Technology (CCHIT) and AHIC which has become National eHealth Collaborative (NeHC)...phew what a collection of names and abbreviations. If you are looking for quick relief from the abbreviation nightmare - this site is useful.

Thursday, May 7, 2009

Social Networking and Healthcare

The network is buzzing with excitement over twitter and social networking and there are increasing numbers of guides, top ten lists and other material aimed at the new participants in the world of twitter. Ashton Kutcher is doing it, Oprah Winfrey is doing it (albeit in CAPITALS initially) - interestingly the race to 1 million followers was close but now Ashton is almost double.

For the Record recently featured an article titled: Healthcare All Atwitter Over Social Networking that looked at the range of social networking tools. Everything from You Tube, Facebook, twitter and blogging is being used by the University of Maryland Medical System (twitter, facebook, blog and youtube links). They attract around 700 people per day that watch videos and read their material - new members, existing patients and more awareness of the system are all good results that will translate into business and good will.
Although healthcare organizations must deal with a unique set of challenges when it comes to establishing and maintaining a presence on social networking sites, they should nonetheless be taking the steps to utilize these sites and tools to reach out to patients and consumers. It is also imperative to monitor what is being said about them by others in the social media space to protect their brands and reputations.
It reminds me a lot of the discussions i was having ten years ago about a web presence with similar resistance to the idea of publishing or spending resource on a web site. Here we are today and it is hard to imagine any facility without a web site (usefulness, design etc widely varied) that is for the most part the online store front. It is not unreasonable to suppose that Social networking is the next innovation in the online/digital world.

In healthcare here is clearly a concern relating to protected health information (PHI) but this is a low cost
"It’s a grand experiment and it may fail, but the cost of entry is so low. It’s not like we have to decide to spend a million dollars to participate on Facebook. It’s more like investing a percentage of an employee’s time to set up an account. Hospitals should be saying ‘We’re here and we’re ready to talk to you.’ … You can just post press releases, or you can become very chatty and friendly. You’ll find out what the best match is for your personality and the way you think of yourself.”
Go ahead take a dip....join me on Twitter (and ranked #27 in the list of top CMO's on twitter), Facebook, LinkedIn, My other Blog - Navigating Healthcare or Plaxo....amongst some of the places I can be found online