Physicians and institutions must accept new reimbursement models and greater patient control, says healthcare CEO at HIMSS.
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While healthcare providers nationwide are just starting to digest the newly proposed rules for Stage 2 of Meaningful Use of electronic health records (EHRs), some forward-thinking organizations are already preparing for Stage 3 and beyond. And it's not just large integrated delivery networks that are looking ahead.
The Alliance of Chicago Community Health Services, an organization that promotes and supports health IT use among safety-net healthcare providers, may serve some of the Windy City's poorest residents, but it has a long-term vision for EHRs.
A properly implemented IT infrastructure will help reverse the trend of increasing costs and questionable quality, according to CEO Dr. Fred Rachman. In a presentation at the 2012 Healthcare Information and Management Systems Society (HIMSS) conference in Las Vegas, Rachman noted that the goals of Meaningful Use include: gains in quality, safety, and efficiency of healthcare; reduction of health disparities between regional and demographic strata; engagement of patients and their families; better care coordination; improved public and population health; and adequate privacy and security for personally identifiable health information.
In Stage 1 of the $27 billion Meaningful Use incentive program, which began last year, providers essentially are being asked to capture and share data electronically. The second stage, starting in 2014, will require clinicians to adopt more advanced care processes and clinical decision support, as well as engage patients, as the U.S. Department of Health and Human Services (HHS) is calling for in a newly released proposal.
Stage 3, as currently envisioned, is supposed to lead to better health outcomes. It's scheduled to start in 2015, but a one-year delay to the second stage likely will push the whole timeline back.
While "we're not in any way ready to leave Stage 1," Rachman said, he advised HIMSS attendees not to lose sight of long-term objectives. "Start thinking about how to meet future requirements now, not just when it's time to make the change," he added.
Rachman reminded the audience that EHRs and Meaningful Use are merely components of broader healthcare reform. Expect to see more alignment between the direction technology is going and the emerging concept of what healthcare is evolving into. "We are still living in a toxic reimbursement system," Rachman said, but the future could look more like the patient-centered medical home model, in which primary care physicians coordinate multiple aspects of care for their patients.
Today, the healthcare industry judges technology based on how well it delivers care in "yesterday's paradigm," according to Rachman. Roles will change for all clinicians, and physicians will be "pushed toward" patient engagement, whether they like it or not, Rachman added. "We are not in charge anymore. The writing is on the wall."
Future health IT will include advanced clinical decision support, functions for managing diseases and patient populations, performance measurement and reporting, electronic prescribing, health information exchange, and patient access to their own health information.
Andrew Hamilton, a registered nurse who serves as COO and director of clinical informatics for the Alliance of Chicago Community Health Services, said that the "Holy Grail" is the center of a Venn diagram encompassing a healthcare institution's EHR, the health information exchange within and between health systems, and each patient's personal health record.
Rachman believes clinicians and institutions will have to get over their perception that they, not patients, "own" medical records. "Many providers still view this as theirs," and they don't much like the shift in perspective, Rachman said.
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