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May 1, 2007
by Charlene Marietti
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Adopting an electronic medical system is only the first step to delivering seamless care

Stark and rules on self-referral and the anti-kick-back law have been revisited and relaxed as pertains to healthcare IT, but there has hardly been a mad rush among healthcare organizations to donate hardware and software to affiliated physicians. One big problem, so say some high profile CIOs, is that there really aren't definitive enough guidelines. Of course, there are concerns about who should receive what, but a dominant theme throughout conversations is, "What, exactly, are the limits of what I can — and cannot — do?" regarding Stark exemptions.

Sad, isn't it, that some of the nation's most influential executives are hemmed by legal constructs. These are people who are highly effective as managers and advisors not only within their own organizations, but also among their peers. Hailed as thought leaders, they are also judicious risk-takers and are typically among the earliest adopters of emerging technologies. And yet, at this point, they're waiting for a test case — and they don't want it to be theirs.

From access to use

But simply having access to healthcare IT doesn't tell the whole story. The Department of Veterans Affairs (VA) and the military are among the most digitized in the country. In dealing with Iraq war casualties, the military has been aggressive in harnessing technology to improve outcomes. In one example, the wounded were being flown from the battlefield to military hospitals outside the war zone and were arriving with incomplete data. Working in the field, the medics were unable to synchronize and update the medical records for the recently treated soldiers. To close the gap, the military shipped handheld computers along with the wounded soldiers.

The VA's Veterans Health Information Systems and Technology Architecture (VISTA), which was introduced in 1996, has received high acclaim for its role in turning around the once-decrepit and care-provider-of-last-resort into a first-rate care delivery system. Physicians leaving VA residency programs often regret leaving the rich, automated support environment offered by VISTA. Not surprisingly, a number of healthcare organizations look to the VA's success story along their paths to automation.

A developing news story, however, is less rosy. According to the New York Times, the Department of Defense (DoD) has been unsuccessful in getting all its hospitals to use a patient tracking system that tracks care for wounded soldiers from field hospitals through treatment delivered state-side. Indeed, fewer than 20 percent of military treatment centers are using the system despite a mandate from the Pentagon nearly two years ago.

The military field hospital in Landstuhl, Germany maintains a staff of clinicians highly skilled in battlefield medicine and receives many soldiers who have been wounded in Iraq. But its medical staff has serious concerns about treatment gaps when soldiers return to care in the United States. Lamenting that the patient care tracking system works well when it's used, one Landstuhl-based medical director has lobbed scathing criticism at the majority of U.S.-based providers who either don't know they can use the system or are unwilling to learn, according to the Times' report.

Technology can be a powerful tool, but only if it's used.