Implementation of HIT in Healthcare Practices
The U.S. healthcare industry is arguably the world’s largest information enterprise. However, use and effective application of Health Information Technology (HIT) remains in its infancy, despite its potential to generate savings, reduce errors and improve outcomes. Today, just half of doctors have HIT systems in their practices, despite the $27 billion taxpayer investment and payment penalties imposed on those that fail to implement it. I recently heard a story about a 45-year old man with chronic diabetes. Each day, he measures his blood glucose and records it using a notebook. His primary care doctor then collects his notes, and nurses manually re-copy them into a paper-based “Diabetes Flow Chart” to manage and track his course of care. Complicating matters, this diabetic has more than one caregiver. He has a dietitian, a diabetes educator, an optometrist, a podiatrist, a dentist, a case manager and a physical trainer. In an ideal world, these providers would all be linked, sharing the same information about his medical history. They’d be talking to each other to develop treatment plans and make sure everything they do is complementary.
Sadly, this isn’t happening, even when most of the providers have advanced HIT capabilities in place. According to a study conducted by Premier and the eHealth Initiative, 88 percent of those with HIT in place have difficulty integrating data from disparate sources—a barrier that only becomes more acute as providers expand their network of medical settings in order to better manage the health of populations. Indeed, as health systems collect data from more care sites and sources, they also report more concerns about interoperability and data management. Interoperability is a significant challenge for 95 percent of organizations using HIT, and is limiting data sharing among providers.
These disconnections have consequences. For one, it requires manual interventions or duplication of data entry into multiple systems, eroding efficiency and potentially introducing human error. For another, because of their closed and proprietary nature, providers must pay their system vendors to custom code links so IT assets can “talk” to one another. In fact, research suggests that efforts to unlock closed systems costs providers $8 billion annually, a core reason why providers report high levels of dissatisfaction with the cost and ROI of HIT.
So what should an ideal HIT system look like?
Technology should make information available in real-time, and be used to create more ownership over outcomes. I often hear providers comment on how little they can control patient behavior. But compare the results of telling someone to exercise to giving a patient a pedometer with an exercise app for their smartphone, all of which generates data that is captured in the health record—similar to what Apple has proposed with HealthKit. In the latter case, the patient has all the tools, anytime access to results and a sense of accountability—fostering more active engagement.
In healthcare, we don’t suffer from a lack of data. But we have trouble putting the data points together to yield intelligence we can act on. Consider a company like Target, which has centralized IT that mines purchasing data, ties it to individuals and uses algorithms to predict future shopping behavior. In healthcare, the Holy Grail is integrated technology to combine the evidence, apply analytics and integrate predictive capabilities to spot emerging health issues and support collaboration across disciplines. To do so, we need our technology to be vendor and payer agnostic, and fully integrated across platforms.
We’re human, and we forget things, which can create gaps in knowledge. Markle Foundation found that many doctors “lose track” of important information nearly a third of the time. And these gaps affect patients, with the Joint Commission estimating that 80 percent of serious medical errors involve miscommunication between caregivers. With data captured automatically, and predictive technology prompting actions, there’s much less for a provider to remember and share with others. Achieving this vision, however, will require some fundamental change.
In April, 2014, scientists from the JASON Advisory Panel found that the lack of interoperability among data sources for HIT is a major impediment to a health data infrastructure like the one I just described. According to both JASON and the President’s Council of Advisors on Science and Technology, reducing fragmentation and improving the usability of healthcare data will require open and secure Application Programming Interfaces (APIs), which enable computer programs to communicate with one another. Requiring APIs would reverse the current state of locked systems and enable real-time exchange of health data across platforms, thus clearing many of the HIT barriers. To advance this work, it may be necessary for the Office of the National Coordinator (ONC) to require open APIs for HIT systems as part of meaningful use.
“As health systems collect data from more care sites and sources, they also report more concerns about interoperability and data management”
It also requires a broader vision that goes beyond a digital health record. As HIT expands to touch larger patient populations across disparate settings, we need a longer-term vision to ensure alignment of data measurement, collection, reporting and analytic efforts that improve care quality, reduce costs and manages patients across the continuum. Today’s IT savvy organizations generally tap clinical and claims data, but we need to be thinking about the processes and standards that are necessary to manage patient-reported measures and unstructured text data. Similarly, providers should be mindful of the changing resources that are required as organizations grow and mature to perform more advanced activities. Staff must be able to leverage HIT to achieve greater improvements in healthcare safety, efficiency and engagement, and organizations should apply technology to risk management.
Despite the limitations, I’m hopeful we can achieve the vision of a technology-enabled healthcare system that is coordinated, where communication is dramatically improved and we aren’t unnecessarily replicating work. Almost every other industry can does this. If we ask for it, we can do it in healthcare, too.
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