Federal stimulus and health care reform

Health care reformWhen is comes to medical diagnostics, the health care industry has always been a technology leader.
The same can't be said for health care information technology as doctors and hospitals have lagged behind other industries in implementing IT.
The Florida Medical Association advises providers wanting to reap the benefits and avoid the risks of health IT adoption to assess their operations carefully, identify benchmarks and a timeline for transition and plan the entire process thoroughly. This means carefully evaluating the provider's own practice and that of its prospective health IT vendor before implemention.

-- Workflow disruption. Decreased productivity.
-- Costly set-up and maintenance.
-- Low technological competence among staff and problems with adjustment, fear of change.
-- Complaints from patients, such as "You talk to the computer, not me."
-- Problems due to technical limits of your practice (For instance, no high-speed connection, etc.).
-- Chosen health IT product doesn't adequately fit your needs (e.g., you have to double-document or sustain paper-based processes and electronic processes).

-- Elimination of chart-pulling, chart-filing, chart loss.
-- Easy electronic review of patient information before visits.
-- Notification of completed diagnostics and labs to review.
-- Notification of required follow-ups, tests, etc.
-- Potential reduction in medical errors with decision support and easier access to relevant information.
-- Reduction in prescription errors and subsequent time lost communicating with pharmacies.
-- Easy communication with patients' other providers -- specialists, hospital visits, etc.
-- More complete and detailed information available for claims, malpractice suits, etc.
-- Potential reduced costs for labor and supplies related to charts and chart maintenance.
-- Improved flow of information between staff members.

That could be changing as the medical world scrambles to prepare for upcoming changes as part of President Barack Obama's Affordable Care Act.

According to the American Medical Association, barriers to widespread health care IT adoption include financial concerns, legal and regulatory issues, technology issues and organization and cultural blocks.

Locally, those barriers already are falling as medical providers roll out the latest technological advances aimed at improving the quality of care for doctors and patients.

From electronic medical records to bar-coded medication charts to Regional Health Care Information Organizations, also known as RHIOs, it's a whole new world for health care IT professionals.

"We look at information technology as being another health care unit," said Joy Bauer, director of information systems for Munroe Regional Medical Center. "We identified that software and hardware by themselves aren't the solutions that our patients need to get better quality outcomes."

To achieve better patient care, Munroe has introduced several IT initiatives.


Albert Santalo, chief executive officer of Miami-based CareCloud, an Internet-based platform allowing doctors, hospitals and clinics to access their system to help manage their practices, including scheduling, accounts receivable and collections, said only about 17 percent of doctors use EMR, an incredibly low number.

"Obama's stimulus bill allocated up to $65,000 per doctor as long as they demonstrate meaningful use of electronic medical records," said Santalo, who was recently named Best Up & Coming Technology Innovator by the Miami Herald. "It's only a first step, but there's a lot more that needs to be done."

Munroe also has introduced bar-coded medication systems at the patient's bedside to prevent negative interactions or dosage errors.

Bauer said it's all part of a plan the hospital started in 1999.

"In 1999, we started asking what we were going to do," Bauer said. "In 2000, we started the implementation. We feel real comfortable we're right where we need to be."

Taylor Dickerson, IT director for Ocala Health System, which includes Ocala Regional Medical Center and West Marion Community Hospital, said the system started an electronic medication administration record to reduce medical errors.

"It requires our staff to go through a few additional steps before they administer a medication, but it improves safety," Dickerson said. "It's not inexpensive, but it's something you have to do once the technology is available."

Dickerson said Ocala Health System has "a lot of directions we're moving into right now" when it comes to health care IT. In May, they introduced tap-and-go, which allows the doctors and staff to tap their name badges on a small reader on their computer and that keeps them logged into the computer system all day.

"It makes it easier to move around the various systems we have and it saves a lot of time and frustration," Dickerson said.

Another change, Dickerson said, is they are moving into a virtualized world with their servers. Nearly 30 percent of the data stored on the world's computers today are medical records and health care institutions constantly need to upgrade their storage systems.

"Instead of having a physical server for every application, we're virtualizing them and that's the latest technology for servers," Dickerson said. "It enables us to put it in a regional area, a virtual server environment with massive storage."

While improved health care IT makes life easier for doctors, hospitals and patients, it does come with a rather large price tag.

"The majority of our patient safety initiatives cost money, they don't save money, but it improves patient care, which is what it's all about," Dickerson said. "It's something that has to be done. There's never enough money to do everything you want to do, but there are certain things you have to do. You have to invest in certain technology regardless of the cost."

Paul Higginbottom, president of Reora and a member of the Ocala/Marion County Chamber of Commerce's technology work group, said it's often tougher for smaller medical practices to invest in IT, though he is seeing more doctors going that route.

"Smaller doctor's offices have really struggled because they tend to be really cautious about bringing new IT in," Higginbottom said. "They kind of drag their feet until they're forced to. There's a lot of opportunities out there for them to go paperless and have better records they can find more quickly, process claims more quickly. It's a huge investment they have to make. There's no free lunch with it and there are a lot of regulatory requirements."

According to the AMA, privacy and security concerns rank second to cost among reason providers resist health care IT. Higginbottom said doctors must have a solution that handles data properly because health care data is second to financial data when is comes to sensitive information.

"Make sure data is encrypted," Higginbottom said. "When it's transmitted from source to source, only certain data can be retained. You have to know who has access to what data. It's all about information handling so it doesn't slip into the wrong hands."

Bauer said her biggest challenge is insuring the IT plan MRMC chooses is the right solution.

"Identify the solution that's going to meet the care and business needs," Bauer said. "IT is a transformational process. It takes the whole hospital to make it work."

Dickerson said in some cases IT makes things easier, but in others there's quite a bit of education involved, so it's vital to have the right people on the job.

"With new technology in an organization, you have to have more experts in that field," Dickerson said. "Some people aren't able to adapt and use the new technology, others go into other things. We're adding employees."

Bauer said there will be a huge demand for people who have a health care/IT background.

"IT doesn't reduce the need for bedside caregivers," Bauer said. "It adds value because they can do a little bit more with the patient."

Santalo said the iPad is another new technology that will have an impact on health care IT.

"We feel it's just a tremendous enabler for doctors," said Santalo. "The iPhone technology was the most rapidly adopted by doctors because it's easy to use. Doctors are mobile -- on call, at the office or the hospital. They need information at their fingertips. The iPad takes it to the next level with a larger screen and better apps."

Another trend, Dickerson said, is RHIOs.

"We're putting a regional health care information organization together here," Dickerson said. "The major health care providers here are involved. We want to make it quicker, better, cheaper when possible and reduce duplication. RHIO would do that."

While technology trends are tough to predict -- Dickerson has been in IT for 25 years and says it's hard to say what's coming in the next three or four years -- most agree health care reform will spur health care IT.

"It's pushing us in the direction of developing our electronic health records so we can communicate with the physicians and share information," Dickerson said. "Our company is investing heavily in that area."

Santalo said reform "absolutely will because it helps to subsidize the adoption of technology. We believe that will be a further enabler of what we're trying to do."

Original article by: Jeff Brooks


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