During a Bipartisan Policy Center event tied to the release of a BPC report on improving health IT safety, several health IT policy experts shared their thoughts on the role of government and the private sector in improving IT’s role in providing safer care as well as industry progress on interoperability.
BPC is a Washington, D.C.-based think tank and, in its report, the organization called for greater private-public leadership, collaboration and a systems-based approach to improve patient safety and information technology.
Former National Coordinator Karen DeSalvo, M.D., who also served as Acting Assistant
Secretary for Health in the Obama Administration, and Andrew von Eschenbach, M.D., former commissioner for the U.S. Food and Drug Administration (FDA) and now president of Samaritan Health Initiatives, were on a panel discussion, moderated by former U.S. Senate Majority Leader Bill Frist, M.D., following the release of the BPC report and the panelists tackled the issue of how to improve health IT as well as the role consumers play in interoperability.
DeSalvo reflected on how the health IT landscape has dramatically changed in the years since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009.
“The iPhone was barely on the market and we weren’t thinking about technology in the way we use it today,” she said. “As an example of how technology enables the practice of medicine, ask a clinician or a nurse about the ability to do drug-drug interactions” versus looking it up. “We now have tools to support and enable that,” she said, also noting that there is ongoing evidence that clinical decision support (CDS) tools improve the safety of care. And along with electronic health records (EHRs), there has been an explosion of other technology that has come on board in the healthcare space.
“The IoT (Internet of Things), the information that patients want to put into their systems, all the other devices in the hospital and there is an array of EHRs that are increasingly using shared standards, but we’re not quite there, and they are interacting with other technologies, including technologies regulated by the FDA and others not regulated. We were trying to get to a place where the standards were common on a floor and encourage sharing of information and build the business case so people have a reason for data to flow,” she said.
DeSalvo added, “The reality is, health IT is in an adolescent phase; it’s still clunky. There are clinicians sitting in a clinical room trying to find information and there is still a lot of hunting and pecking going on. We still have a great deal to do to streamline that and reduce some of the noise in the systems, so the signal comes out more clearly, and that’s part of the usability.”
Karen DeSalvo, M.D.
She also acknowledged the documentation burden that many clinicians face when using EHRs, and the need to ensure accurate patient identification. “There is interesting work going on in that space. The data is accumulating, EHRs are making care safer and making the practice of medicine better, but it needs to be smoothed and easier to use the systems. And, we need to make sure we’re linking the right care plans and medications with the right patient, not just in that care setting, but also globally,” she said.
In its patient safety and health IT report, BPC recommended the development of a coordinated public-private leadership effort to set health IT safety priorities. DeSalvo said she agrees that more colllaboration is needed.
“The private sector has to step up and create a safe environment where they can share information about what’s working, what’s not working and how to solve safety issues that arise,” DeSalvo said. “Safety and security kept me up at night. There are people who will report problems but not everybody is going to be a good actor.” She added that there needs to be peer pressure to get everybody to do the right thing. “And, it’s not just the big developers and big health systems that are engaged, you want to make sure you don’t leave anybody behind, such as the rural hospitals and the federally qualified health centers.”
The discussion turned to the challenges of achieving interoperability, and von Eschenbach noted that interoperability issues are as much a cultural challenge as a technical one. “Physicians, and I’ll take the blame as a surgeon, we grew up in a culture that was highly individualistic, today the game is about being a team that has to work together. Whatever part we’re playing, we have to learn to come together and work together in a collaborative, interoperative way.”
Frist asserted that the movement toward value-based payment and value-based care could be a driver for a more team-based culture. “I don’t think you can get there without a team-based culture,” von Eschenbach said, adding, “The reason why it’s so critically important is the data management systems are giving us the toolkit, and we struggle with variability—variation in the diseases, variation in the person with the disease, variation in the treatment—and to manage that variation you need data and information systems to do it. When you do that effectively, you reduce variance, which improves quality for any group of patients.”
The movement to value-based payment is a big driver to get health systems to think about coordination of care, DeSalvo said, as “the more risk you take, the more you need to see on your dashboard where patients are getting care outside of your system” and access to better data often drives a change in behavior, she added.
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