Transforming Healthcare Through IT
By Ray Valek
Health information technology is helping close healthcare’s quality, safety and cost gaps and putting an industry’s focus back where it belongs: on the patient.
Flying home to Chicago last winter, HIMSS President and CEO H. Stephen Lieber, CAE, began suffering abdominal pain. After his plane landed, he was driven to his doctor, who, after conducting a blood test, immediately transferred Lieber to the emergency room.
At the ER, the same blood test had to be repeated before emergency surgery was performed to remove his appendix. “They don’t have systems that talk to each other,” Lieber observes. “Repeating a blood test was a medical waste,” delaying Lieber’s surgery, increasing his discomfort and adding unnecessary
Multiply the cost of Lieber’s one unnecessarily repeated test exponentially, and you can begin to understand how a national network of health information enabled by technology can reduce waste and related spending while improving healthcare quality and safety.
A Rand Corporation research report published in 2005 conservatively estimated that $77 billion per year could be saved if most hospitals and doctors’ offices adopted health information technology (IT). More importantly, implementing this technology has proved to reduce medical errors, Lieber says, and associated injuries and deaths. A new Society of Actuaries study released in August 2010 reports that 1.5 million medical errors each year in the U.S. can be identified through insurance claims data alone, and suggests that the real number is much higher. Medical errors cause about 200,000 deaths a year, according to an investigation by the Hearst Corporation.
Health IT Promises to Improve Medical Outcomes And Reduce Expense
As HIMSS celebrates its 50th anniversary this year, it is playing a leadership role in efforts to use health IT to help transform a healthcare industry with serious quality, safety and cost problems. This technology—including electronic health records (EHRs), e-prescribing, clinical decision support, health information exchanges and more—can improve medical outcomes and reduce expenses by providing rapid access to patient and clinical data.
Evidence-Based Care Considerations Improve Care Quality
ActiveHealth Management, a subsidiary of Aetna, Inc., analyzes medical data from health plans, pharmacy benefit managers, laboratories and other sources on 19 million Americans to whom it provides health management services today. These data power CareEngine®, the company’s clinical decision support capability, which “identifies gaps between the care that individuals are actually receiving and the care they should be receiving as reflected in the medical literature,” says Active-Health Management’s President and CEO, Gregory Steinberg, M.D.
“Doctors are being paid for what they do, as opposed to being paid to provide better quality. To make quality happen, you need tools that allow data to be analyzed and transformed into actionable information.”
Gregory Steinberg, M.D., President & CEO, ActiveHealth Management
CareEngine uses evidence-based care alerts called Care Considerations to communicate with physicians and patients via secure online portals, EMRs (electronic medical records), mail, fax and, in urgent situations, telephone. In 2009, 16 million individualized Care Consideration messages were communicated to physicians and patients, closing discrepancies in care.
NaviNet Provides “Unified Patient Information Management”
Aetna sends member Care Considerations to healthcare providers via NaviNet, the nation’s largest real-time healthcare communications network. Through NaviNet, hospitals and medical groups can securely exchange patient information with health insurers, and healthcare technology and service providers. This centralized, real-time information facilitates proactive and cost-efficient care, says NaviNet CEO Brad Waugh. “For the patient, this translates into a smoother experience at the doctor’s office—they have your medical history, your benefits information, your billing information and more. You don’t have to make multiple phone calls and send faxes to multiple providers to get your medical information to the right physicians,” he explains.
Waugh calls NaviNet’s service “unified patient information management.” It brings together separate pieces of information from health plans, patients, providers and others into one place to present a singular view of the patient.
“Healthcare today is where the financial industry was decades ago,” Waugh continues. “There used to be disparate, unconnected financial networks, but now you can securely process financial transactions from anywhere in the world. This is what we predict will happen in healthcare. All stakeholders—providers, insurers, IT vendors and, most importantly, patients—will be able to safely and securely access and exchange meaningful patient data regardless of their location. This will dramatically improve the patient experience.”
Nemours—Embracing Digital Work Flow
At Nemours, a health system that provides care to 250,000 children in four states, Chief Medical Information Officer Dr. David Milov and the Nemours Health Informatics team lead a successful effort to seamlessly disseminate health information throughout the organization.
Nemours uses EMRs that are fully integrated between its inpatient and outpatient care facilities, operating rooms, and emergency and radiology departments. Its consumer Web site (www.kidshealth.org) is extraordinarily empowering for patients and parents, says Dr. Milov, because of its ability to link relevant content to a specific health record. The EMRs that Nemours’ pediatricians use display links to supporting Web site content, which doctors can then select and issue to families at the point of care to help them better understand their child’s diagnosis. Purchased and rebranded by 40 pediatric hospitals across the country, KidsHealth.org also benefits parents and children outside of the Nemours system. The most-visited pediatric Web site, KidsHealth recently celebrated its one-billionth visitor.
Dr. Milov emphasizes that Nemours “paid the price, culturally” for these achievements. “The economic costs are often cited as prohibitive, but the cultural change required to do digital work flow is equally challenging,” Dr. Milov points out.
Helping physicians overcome concerns about work flow disruption and see the value of EMRs was key to Nemours’ effort, he says. “If physicians view EMRs as merely a data entry tool and they never get data back, they’ll never improve; they’ll never get better at it, and never love it,” he explains. However, when doctors receive data back comparing their performance to that of their peers or to a standard, “they get very excited about EMRs. Doctors need to see the value of their laborious data entry activities. When they see that, they become believers.”
Hard Numbers Prove the Point
While there is general agreement that health IT can improve healthcare quality, skeptics doubt that it can reduce costs.
ActiveHealth worked with a 40,000-member health plan in Cleveland to implement a randomized, controlled clinical trial—designed to produce the highest level of evidence—to measure whether Care Considerations would improve quality as measured by reduced hospitalizations, while simultaneously reducing costs. For one year, a study group of 20,000 members received Care Considerations; 20,000 members in a control group did not.
“Healthcare today is where the financial industry was decades ago. There used to be disparate, unconnected financial networks, but now you can securely process financial transactions from anywhere in the world. This is what we predict will happen in healthcare. All stakeholders—providers, insurers, IT vendors and, most importantly, patients—will be able to safely and securely access and exchange meaningful patient data regardless of their location. This will dramatically improve the patient experience.”
Brad Waugh, CEO, NaviNet
The American Journal of Managed Care published the study’s results: The study group receiving Care Considerations had a statistically significant decrease in hospitalization rates and costs.
Later, the Journal of Health Economics published a verification of the study’s results relating to costs, which reviewed data that showed charges were the same for both groups during one-year periods both before and after the study. However, during the study, the study group had 6% lower charges, which the article concluded was due to the Care Considerations. “There is objective information that says arming physicians with information about healthcare quality does actually translate into reduction of costs,” Dr. Steinberg emphasizes. “Doing the right thing not only improves care, but also lowers costs.”
Collaboration Leads To the “Right Answer”
HIMSS’ Lieber says the encouraging links being made between higher quality and lower costs are the product of collaboration. “This has always been fundamental to HIMSS—in everything we do, we involve all of the relevant stakeholders.” He says, for example, a room full of vendors will give you the vendors’ answer, while a room full of users will give you the users’ answer. “But if you get them together, and there’s back and forth that occurs, you’re more likely to come up with the right answer.”
Over the years, he has seen HIMSS grow from an organization primarily for individual management systems engineers into one in which individual and corporate members are focused on transforming healthcare through IT. He also has seen federal government support increase: For example, a $21 billion investment in health IT was included in the American Reinvestment and Recovery Act of 2009.
ActiveHealth and IBM — Delivering CareEngine Through Cloud Computing
This national commitment is spurring innovation, such as ActiveHealth’s partnership with IBM. Its new Collaborative Care Solution combines information from EMRs, claims, medication and lab data with ActiveHealth’s CareEngine and delivers it through an IBM cloud computing platform. The solution promises to help doctors make more complete and accurate decisions about patient care, and reduce medical mistakes and unnecessary, costly treatments.
Aligning Reimbursement With Quality
Dr. Steinberg sees health IT initiatives as essential steps toward better aligning reimbursement with quality. “Doctors are being paid for what they do, as opposed to being paid to provide better quality. To make quality happen, you need tools that allow data to be analyzed and transformed into actionable information.”