Healthcare is one of the most information-intensive and technologically advanced industries in our society. Yet most physicians and hospitals still use information systems that are largely paper-based. Four major challenges contribute to this situation:
• Healthcare consists of lots of small organizations that have a difficult time funding IT investments and rarely have trained IT staff to assist in selecting and implementing products.
• Although many healthcare apps have the potential to improve care--think e-prescribing systems that reduce adverse drug events--insurers don't always reimburse healthcare providers for delivering quality care, so providers see no financial gain from investing in IT.
• A lack of data and transaction standards and few financial incentives have hindered the development of information exchange networks among healthcare providers.
• Treatment pathways or protocols have been developed for some diseases like diabetes and hypertension, but for the vast majority of the 10,000 diseases, syndromes, and problems that exist, care tends toward trial and error. This situation is exacerbated by the huge amount of information added to the base of medical literature each year, requiring us to continually revisit our understanding of how we provide care.
Several steps should be taken to address these challenges and ensure that providers take advantage of the significant gains that can come from IT.
1. Payment Reform: New federal initiatives give providers financial incentives to adopt EHRs and "meaningfully use" them. And the recently passed health reform legislation signals that the government plans to start basing provider payments on quality of care, safety, and efficiency, all of which will lead to further EHR usage.
The result will be a snowball effect. Private sector payers likely will follow the government's lead on payment reform, and groups that manage physician board certification and licensing now are considering making EHR use part of their requirements.
2. Provider Support: The federal government has awarded $700 million in contracts to establish regional centers to help small hospitals and physician practices select and implement EHRs. It's also providing $500 million to help states establish the health information exchanges needed to share patient data. These exchanges will need sources of ongoing funding. One possibility is charging hospitals transaction fees to use them.
3. Product Improvement: For small providers, it's neither practical nor cost effective for them to manage their own IT infrastructures. They're a receptive market for cloud-based EHRs and pay-per-use models that let them avoid the up-front capital costs.
In addition, sophisticated and intuitive user interfaces are a must. No physician wants to scroll through a list of 10,000 possible problems when working in an EHR. Products must be designed to "think like a doctor."
4. Privacy And Security: There are legitimate concerns here. Federal and state governments are enacting regulations that cover disclosure, encryption, audit trails, and authentication. Technologies are needed that support these requirements and don't unduly interfere with the delivery of patient care.
In years past, physicians and other healthcare professionals resisted IT. That era is behind us. Virtually everyone understands that EHRs are the future. Our ability to use technology to improve care will be enhanced considerably if we address these four areas.
John Glaser is CIO of Partners HealthCare. This month, he'll leave Partners to become CEO of Siemens Healthcare's Health Services business unit. He recently spent a year as an adviser to the national health IT coordinator, Dr. David Blumenthal.