Tuesday, May 15, 2012

HIT Improves Patient Care

The importance of health IT to improve patient safety and quality was the topic at the May 9th Steering Committee on Telehealth and Healthcare Informatics panel held on Capitol Hill. Neal Neuberger, Executive Director for the HIMSS Institute for e-Health Policy and the organizer for the event, is anxious to see the convergence of health IT and quality that will greatly improve the safety needs for all patients.

As panel moderator, Don E. Detmer M.D., Medical Director of the Division of Advocacy and Health Policy for the, American College of Surgeons commented on the Institute of Medicine’s November 2011 report “Health IT and Patient Safety: Building Safer Systems for Better Care”. As he pointed out, IOM recommends making improvements to the reporting of health IT safety incidents but also the importance for monitoring of health IT products.

Senator Sheldon Whitehouse (D-RI) told the attendees that he is requesting that meaningful use be amended to also address the needs of behavioral providers in order for reimbursement to be provided. Always interested in this issue, the Senator in 2011 introduced the “Behavioral Health Information Technology Act”.

As the Senator explained, “Since mental health and behavioral providers are frozen out of meaningful use, meaningful use needs to be amended  and pilots need to be initiated to address the specific needs of behavior and mental health providers.”

Also, the Senator in March 2012 released a report to the Senate Committee on Health, Education, Labor, & Pension (HELP) concerning ACA’s impact on health reform. The report details how ruling the ACA unconstitutional would hamper health IT. To further discuss the issue, the Senator is chairing the HELP committee’s May 16th hearing on healthcare delivery system reform.

Also attending the Capitol Hill event, Representative Erik Paulsen (R-MN) the Co-Chair of the Medical Technology Caucus in the House is happy to see health IT receive so much attention. He introduced “The Protect Medical Innovation Act” in 2011 (H.R 436) that would amend the Internal Revenue Code and repeal the excise tax on medical devices. He is hoping to see the medical device tax repeal effort come to the House floor in 2012.

HHS was represented on the panel, as Kevin Larsen, M.D., Medical Director for Meaningful Use, within ONC, is responsible for coordinating the clinical quality measures for Meaningful Use Certification. He told the attendees that ONC has proposed capabilities, related standards, and implementation specifications that certified EHR technology users will need to consider.

Laura L. Adams, President and CEO of the Rhode Island Quality Institute, recounted how a while back, she gave an overdose of medicine to a child in a hospital. The child almost died but fortunately did survive. She has asked herself the question many times “How did this happen?”

As she explained, before the drug was given to the child, paper records were handed around six times from person to person. This is a situation that can lead to mistakes that are often easily made since so many people are handling the information. Sometimes just one decimal point out of place can create a dangerous situation in terms of safety for the hospital staff and for the patient.

Adams overall is looking at changes that need to take place in the healthcare system. As she commented, “We can start by using HIT to improve quality—not just to measure quality. But equally important, it is vital to shift the payment system from volume to value as quickly as possible and not make payments to providers on a piecework basis. Today’s system makes it possible for the worst cardiac surgeon, primary care doctor, etc., typically to get paid the same as the best.”

Equally important, data must follow the patient through community-wide HIEs where hospitals, laboratories, pharmacies payers, ambulatory centers, public health primary care providers, patients and families, and specialty physicians contribute to the electronic record.

Optum Health Inc, a health services company with 60 million individuals, supports 1 in 5 emergency department visits, manages programs for 1 out of every 4 Medicaid recipients, and provides for 4.5 billion electronic transactions per month reports Ted Hoy, Sr. Vice President and General Manager for Optum Cloud Solutions.

Optum Health like many others is faced with the major challenge of dealing with interoperability in today’s healthcare world. As Hoy pointed out, there are a number of factors affecting the current state of interoperability. Today, top concerns are standards and policy issues, lack of fully aligned commercial objectives, working with the new delivery models such as ACOs and medical homes, and dealing with episodic care models like bundled payments.

One of the most important requirements related to interoperability is that all information must be shared seamlessly between all stakeholders in the system. As Hoy explained, unfortunately, many EHR systems already in place are stand-alone closed applications that effectively block the flow of information and are not designed to share information more broadly across all care settings.
How health IT plays an important role part in the Bronx community was described by Eric Gayle, M.D., New York Regional Medical Director for the Institute for Family Health. He emphasized that in order to improve patient safety using IT is essential to provide point-of-care checks and reviews. Also, in the Bronx healthcare community, evidence-based alerts and specific to the patient play a central role.

Screenings are provided for colorectal screening in appropriate age groups, depression screening for the adult population, PPD screening in patients with HIV, and finger stick glucose testing in patients with diabetes plus other screening events

Maggie Lohnes, Healthcare Principal, at the Mitre Corporation, presented her comments representing HIMSS. She is Co-Chair of the HIMSS Quality, Cost & Safety Committee. She recently led the HIMSS eMeasures Recommendations Task Force. Lohnes presented the highlights included in the nine eMeasures recommendations formally sent to the HHS Secretary.

A few of the recommended highlights include developing and funding an industry-standard clinical value set library to be used for eMeasure development, developing a central portal for distribution of eMeasure specifications to easily identify, download, and monitor for changes, requiring that the eMeasure testing process include a testing site plus developing an implementation guide to be used by vendors.

For more information on future briefings, email asimmons@e-healthpolicy.org or email neal@e-healthpolicy.org.