Healthcare // Analytics
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6/20/2013
12:09 PM
Paul Cerrato
Paul Cerrato
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IT Can't Fix Complex Healthcare Problems

It took the U.S. healthcare system decades to dig the hole it's in. We'll need more than technological innovations to dig out.

 7 Portals Powering Patient Engagement
7 Portals Powering Patient Engagement
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A lot has been written about the need for better care coordination to rein in healthcare costs and lower the high readmission rates in U.S. hospitals. Tech vendors and medical researchers have been trying to parse all the variables to figure out what tactics we need to fix the system. It looks like we're moving in the right direction, but there's a long road ahead. A closer look at the data makes that clear.

In principle, more emphasis on care coordination and the IT tools designed to manage it makes sense. When each clinician across the continuum of care knows what everyone else in the system is doing, the quality of care should improve and the costs should drop. If, for instance, the surgery team about to perform a coronary bypass procedure has all the details from a primary care doctor about the patient's medications and allergies, there's less risk of interaction between the anesthetic and those meds. And if the ambulatory clinician handling the patient's recovery has details on the patient's discharge instructions, that clinician can help the patient adhere to a postoperative regimen.

Such a well-coordinated approach could also cut costs by reducing needless duplicative diagnostic tests. If the electronic medical record (EMR) contains notes about a recent serum potassium, EKG or MRI test, there may be no reason for the next clinician in the chain to reorder it.

[ A physicians group finds payoffs in unexpected places after moving some business ops to the Web. See Digital Business Requires Dose Of Humility. ]

EMR systems that don't talk to one another across this continuum create a barrier to making this process work. If the hospital where this cardiac patient had surgery is a Cerner shop, but the patient's family physician uses PracticeFusion or DrChrono, they may not communicate well enough for the ambulatory doctor to get all the needed details. As many doctors in the trenches know, interoperability remains a major barrier to care coordination.

Another barrier is insurance coverage for physicians who are trying to make care coordination a reality. Until recently, they were not adequately reimbursed for time spent on care coordination, but in 2013, CPT codes for managing transitional care were put into the CPT codebook. CPT 99495, for instance, covers "communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge and "a face-to-face visit within 14 calendar days of discharge." That's a major step forward. Unfortunately, reimbursement codes are only part of the solution.

Poor care coordination is partially responsible for the high hospital readmission rates in U.S. hospitals, and reining in this problem is proving far more complex than anyone imagined.

There have been significant advances in hospital readmission prevention. Jacques Donze, MD, and his colleagues at Harvard Medical School analyzed thousands of EMRs to identify seven critical signposts that predict a patient's likelihood of being readmitted for a preventable problem. They include low sodium and hemoglobin at discharge, a length of stay of five or more days, and discharge from an oncology unit. Using these seven markers, the researchers created a scorecard to help clinicians predict who is most likely to be readmitted so that these patients can be targeted for special consideration.

But, put this positive development in the context of other less-than-successful initiatives. Medicare has spent serious money funding 34 demonstration projects, the aim of which has been to reduce costs by preventing hospitalization and enhancing care coordination. After collecting data for 10 years, the Congressional Budget Office (CBO) reports "no net effect on hospital admissions or Medicare expenditures," according to a report by Ari Hoffman, MD, and Ezekiel Emanuel, MD, PhD, in the Journal of the American Medical Association.

So what's fundamentally wrong? CBO offered some insights, stating that new electronic systems can "make it easier to reduce health spending if other steps in the broader healthcare system are also taken to alter incentives to promote savings ... [but] by itself, the adoption of more health IT is generally not sufficient to produce significant cost savings." Which is a long way of saying: IT itself can't fix complex healthcare problems.

What we really need is a reengineered healthcare system. Hoffman and Emanuel, from the University of California, San Francisco and University of Pennsylvania respectively, are on the right track in recommending such an overhaul.

Hoffman and Emanuel offer a solution similar to CBO's: "Clinicians need to abandon their long established approach of caring for patients in the hospital or the office. They have to provide constant access to a clinician who knows the patient and encourage communication with whatever mode patients are comfortable with -- telephone, e-mail or office visits." That approach also calls for wireless monitoring, telemedicine visits, at-home care and full patient engagement.

We're passed the stage where incremental improvements will work.

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Alex Kane Rudansky
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Alex Kane Rudansky,
User Rank: Author
7/8/2013 | 9:20:47 PM
re: IT Can't Fix Complex Healthcare Problems
I wonder how realistic the development of a centralized system actually is. Would all of these existing IT companies be willing to change their structures to work together? What would be the financial consequence of that?
SusuE709
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SusuE709,
User Rank: Apprentice
7/6/2013 | 4:07:49 PM
re: IT Can't Fix Complex Healthcare Problems
I agree with what you wrote. health care is better than cure. to maintain body condition, drinking milk Etawa susu kambing etawa
jaysimmons
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jaysimmons,
User Rank: Apprentice
7/1/2013 | 1:55:16 AM
re: IT Can't Fix Complex Healthcare Problems
I agree, we canG«÷t just rely solely on health IT and hope
that the solutions present themselves with more use of technology. If we want
to reduce costs and realize the goal of better patient care, we need to improve
on all aspects of healthcare. IT may provide a means to these solutions but
physicians, patients, vendors, and organizations in general have to change.
Improved, more efficient healthcare requires a cultural shift.

Jay Simmons
Information Week Contributor
amylc433
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amylc433,
User Rank: Apprentice
6/25/2013 | 4:50:22 PM
re: IT Can't Fix Complex Healthcare Problems
The answer is no longer EMRs, like you said - they do not inherently connect to each other. The industry now is in HIEs, which take all of that information and put it into one place. The Cerner hospital's information and the PracticeFusion hospital's information. Also, hospitals typically have many disparate solutions - using different vendors for lab results, vital signs, radiology, etc. All of that information within ONE hospital/practice is not in the same place. With all of this being said, an HIE is vital for the best patient care.

Technology can be used to help patients get better, but instead of using technology from a Health IT company, one would be wise to look into technology (HIEs, specifically) from a Health Care Company - one whose history has been helping people get better. Not one whose history has been making considerable profit on shiny tools, and not one who is run by a payer (insurance company), because their motives may lye in the wrong place.

I work for Alere (ACS, which is the HIE). Alere is a $3 billion Health Care Company. One of our clients just released a statement saying that they reduced ER utilization within their population of Chronic Disease patients (the highest cost patients for insurance companies), by 20%, by using our HIE, in addition to care management and analytics of the information that was collected.

It is possible.
bemmerson570
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bemmerson570,
User Rank: Apprentice
6/25/2013 | 10:41:05 AM
re: IT Can't Fix Complex Healthcare Problems
I write about M2M and there is a solid business case for eHealth solutions, but it is all too easy to overhype the technology. For example, when a problem is detected with an elderly person at home to shut down the security system to facilitates entry, schedule a specialist to be ready when they arrive at hospital, reserve a bed, etc, etc. I recently read a scenario that went along those line and on the same day there was a story in the UK media about a student surgeon removing the wrong organ from a pregnant woman who subsequently died. The supervising surgeon was also a student. Hospitals can fix issues like that, as well as leaving instruments inside patients, before taking complex IT on board.
Allan_S
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Allan_S,
User Rank: Apprentice
6/21/2013 | 3:41:57 PM
re: IT Can't Fix Complex Healthcare Problems
I have a chiropractor whose full charge for a normal visit is $25. That's not the co-pay, that's the full cost.
I once asked her how she was able to charge so much less than the competition and she pointed to the typewriter behind the receptionist and said "No computers." No hardware or networking or security or software costs, no training or outage issues and her HIPAA compliance was the cost for a good padlock her patient files.

Now, I'm not a luddite recommending the elimination of computers from the health industry, but offer an anecdotal story to support the CBO's finding.

Don't be afraid to tell the vendors 'No' if there aren't solid and convincing reasons to implement - sometimes less (IT) is more (cost/patient effective). At the very least in one case zero IT infrastructure was the best solution.
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