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One CIO's Random Thoughts on Healthcare (Part 2 of 3)

October 6, 2009
by Neal Ganguly
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(From Part 1 – Oct 3rd)

It’s the week after National HIT Week in Washington DC, and I’ve been trying to process and reconcile a lot of what I heard there and what I’ve been reading with the daily challenges of running a hospital IT shop.

The key themes from Washington were effective use of Stimulus dollars; reform of the healthcare system; and the meaningful use of technology to accomplish that reform. This brought a number of thoughts to my mind. I started to think about the drivers around ARRA and how the industry was reacting to it. I thought about the current delivery system and some of the things that were ‘broken’ from a CIO’s standpoint (at least my standpoint). Finally, I spent a lot of time trying to formulate a plan to deal with all of the above. I’ll split my thoughts into three documents to make it more readable (hopefully).

(Part 2 of 3)

In this second part, I cover some of the thoughts that came to my mind regarding problems in our current system from my perspective as a community hospital CIO. Some of the things that sprang to mind were the lack of alignment between the players in healthcare – particularly the physician & the hospital; the patient & the provider; and the hospital & regulatory agencies.

Physician – Hospital Alignment.

I was fortunate to hear a presentation by the CIO of CMS and listened as she challenged the assembled CIOs to think about a vision of the future of healthcare. One based more on outcomes and quality than on claims and transactions. That got me thinking about some of today’s challenges such as RAC audits, etc. The lack of alignment between physicians and the hospital came to mind. Sure, meaningful use helps drive us towards the establishment of a technology infrastructure, but what about lower hanging fruit? Aligning the payments of the physician and the hospital would be a good start. Hospitals must often sacrifice revenue due to poor physician documentation and physicians have no financial incentive to document in support of the care rendered by the hospital. If there was alignment, it would help ease the endless battle between the hospital coders & billers and the physicians – and maybe drive some compliance in proper documentation that could help drive quality. There are other elements of physician – hospital alignment that should be addressed, but this seemed like a good starting point as I sat in Washington.

Patient – Provider Alignment.

As I listened (okay, eavesdropped) on a conversation between attendees at HIT Week, I heard mention of the PHR being an early component of the meaningful use definition. That started me thinking about the way patients and providers interact today. In a world driven by email, texting, social networking, and the internet, we still primarily interact with our providers face to face. Information is still kept in local silos, and rarely shared effectively. The ARRA recognizes the need to share information and tries to incent the industry in that direction, but is the PHR something to start with? To me it implies that the general public should take ownership of their medical records – and I think they should…ultimately. By that I mean they should do so after there is a sufficiently robust infrastructure to make the patient owned record easily transferable in a meaningful way. This would be one where the PHR would be updated automatically as a byproduct of care delivery, be viewed in any appropriate venue, and support the modern methods of human interaction mentioned above. However, this robust infrastructure must start with the building blocks of the EMR in the provider setting, and the exchange of data between providers, which is no small feat. In my opinion, only after this large hurdle is overcome, should we focus on the PHR.

Reporting Requirements

Hospitals devote a great deal of time and resources to compliance with regulatory mandates. Much of the effort involved in meeting these mandates involves the actual collection of the information – often a manual process due to the lack of comprehensive electronic documentation. Progress notes are a key source of data for regulatory compliance. These notes are often handwritten because clinicians can write (albeit sometimes illegibly) faster than they can type. This leads back to a misalignment between the clinician and the hospital. If clinician behavior could be changed in favor of electronic progress notes, there could be a reduction in resources required to generate regulatory reports. The problem is the fact that the doctor is driven by time. More time documenting equals less time seeing patients equals less revenue. Nurses often have to cover 6 patients at a time and more time documenting equals less time at the bedside. In this example, the benefits of online progress notes flow to the organization, not to the documenters. Are pay for performance and other quality based payment systems a way around this dilemma? I’m not sure, but if we are to squeeze costs out of the healthcare system, much of this manual effort will need to be reduced or eliminated by some transfer of work effort.

Again, these are just one CIO’s thoughts on just a few of the things that appear in need of a little paint and spackle. There are obviously many other things in our healthcare system that are broken, as there are many great things about our system. In the next and final part, I will discuss how I and my team are trying to gear up to address some of these challenges.

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