Engaging Clinicians in Information Technology and Health Information Exchange

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Engaging Clinicians in Information Technology and
Health Information Exchange

• Peter Basch, MD
• Medical Director
• MedStar eHealth Initiative

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The Value of Information Technology

• Improving quality
• Embedded care guidelines
• Disease management
• Reducing inappropriate variability
• Improving safety
• CPOE
• ePrescribing
• Reducing costs
• Reducing unnecessary duplicative testing
• Reducing hospitalizations, office visits,
  sequellae of chronic disease

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And health information exchange

• Improving quality
• Fewer patients treated on limited information
• Improving safety
• Medications prescribed in fuller context
• Reducing costs
• Reducing unnecessary duplicative testing

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The stars have aligned

• Strongly endorsed by Bush and Thompson
• CMS demonstration projects
• NHII
• Medicare Modernization Act and eRx
• Health IT coordinator
• Multiple bills before Congress promoting IT

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Clinician adoption of IT remains low

• 3 of hospitals using CPOE
• 5-20 of clinicians using EHR
• 7-30 of clinicians using eRx
• HIE used by lt1 of clinicians
• 100 of clinicians use procedural / imaging
  technology

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Why do clinicians need to be engaged with HIT?

• Hardware, software and networking costs
• Bandwidth issues
• Usability
• Technophobia
• Lack of standards / interoperability
• Cultural issues
• Business case

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What can make care better
Missing / relevant information
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Can lead to unintended consequences
Care confusion
Missing / relevant information
Expanded duty / liability
Too much / irrelevant information
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The consequences of having all information on all
patients all the time

• Average generalist sees 20-30 patients/day gets
  labs on ½ of them
• Takes 20-60 minutes a day to review, interpret,
  integrate, act on, communicate to patient
• If all results pushed to all providers with
  relationship to patient
• Could increase work 6-fold ( to 2-6 hours a day!)
  and if this is uncompensated, will either
  increase time in office or reduce billable time
  by 25-50 (enough to ruin most practices)

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Expansion of duty / liability

• Within the model of siloed care, duty is narrowly
  defined - only for what you do (or can be proved
  to have known, or should have known)
• Once the information enters your record, you are
  responsible for it (even if you didnt order it,
  or understand it)
• And what if the information is not in the record,
  but could easily have been put in it
  (reasonableness may be redefined if information
  is just a click away, or could have been
  auto-pushed to the chart, if the clinician had
  appropriately set the default in the
  interconnected EHR)?
• In the midst of a nationwide liability crisis, is
  this a welcome change?

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Does more information to more providers improve
care?

• Meaningfulness of information to some providers
• Does quality improve when multiple providers (who
  are informed, but unqualified) recommend a
  course of action?
• Or when multiple informed (and qualified)
  providers chart reasonable, but different courses
  (unanticipated / unwanted second opinions)?

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Despite challenges, change must occur

• US leads the world in advanced procedures,
  imaging technology, and medication development
  yet lags significantly behind many countries in
  many parameters of quality and safety
• Growing expectations of patients and doctors
• Increasing numbers of carrots and sticks

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Change will occur thru

• Technologic advances
• Policy / reimbursement changes
• Clear understanding of duty / liability in an
  interconnected world
• Clinicians helping to redesign workflow, such
  that connectivity better care

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Panelists

• Patricia Hale, PhD, MD, FACP
• Brian Keaton, MD, FACEP
• Judy Murphy, RN, BSN
• Tom Sullivan, MD
• Steve Waldren, MD

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Why do clinicians need to be engaged with HIT?

• Hardware, software and networking costs
• Bandwidth issues
• Usability
• Lack of standards / interoperability
• Technophobia
• Cultural issues
• Business case

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Physician culture are there special
challenges?
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Is the business case for IT the same for
all clinicians in all settings?
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Success stories
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Baby steps or giant leaps is
incremental adoption the best way to succeed?
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Its all about workflow, or is it?When
do you adjust the application, When do you change
the workflow?
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Health information exchange

• Is it needed?
• Aside from connectivity technology and data
  standards, what is needed to ensure that its use
  improves care?
• Do clinicians need additional incentives to
  participate in health information exchanges?

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Questions from the audience
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Last words

• David Brailer has taken a temporary leave of
  absence, post, finding Washington DC summers just
  too hot! You are being considered by Secretary
  Thompson as the interim IT czar. You know that
  President Bush wants to have all clinicians using
  EHRs within 10 years, and Thompson, being less
  patient, wants it done this year. In 30 seconds
  or less, what is the most important thing that
  can be done to realize this objective.