re: How 3 ACOs Use Technology To Survive
I just read, with interest, your article in Information Week about how three ACO's are using technology to survive. It is a good article, however I want to make a few comments. I am re-entering the field of medicine after a 12-year absence from clinical practice. Back in 2001, hospitals were just beginning to talk about EMR. I had a little experience with the VA system in Northern California. I am hopeful that data can be used in ways to increase my productivity as well as promote conditions that generally enhance patient safety and general well-being.
During the past 5 years I went back to graduate school and earned an MBA in General Business Administration. I learned there that in general, IT projects have failed to deliver expected gains in productivity approximately 65% of the time, across all industries. Why should we think that healthcare industry would be any different?
I have talked to some of my former colleagues who are now working with EMR, usually because it has been imposed upon them by the hospital system with which they are under. They tell me that productivity has gone down. Before EMR they could easily see 25 patients a day in our specialty. Now they can barely see 16 patients a day. This is a considerable drop, and they are into EMR two years or longer now. Isn't there data available on this drop? I would really like to know what kinds of date the hospital systems are collecting regarding adoption and how they are using this data to improve adoption and productivity. If productivity suffers permanently, how can we say that EMR is good for overall healthcare, given the current doctor shortage? In another way of speaking, isn't being seen by a doctor when you need one more important to overall healthcare than EMR adoption?
Another thing that concerns me is the data being gathered and how it is looked at. Sure, it's easy to design EMR with alerts for needed vaccinations and medication renewals, but I thought there was a movement within healthcare IT to design program functionality around the needs of doctors and other team members delivering care, instead of programming for needs that are defined by IT professionals with no healthcare experience or training.
For example, a doctor doesn't need an EMR program to alert him to the fact that a 94 year-old male with chronic renal failure and hypertension needs to be on the High Risk Medicare Roster. Furthermore, unless someone is constantly performing home visits and reminding the patient weekly to cut down on salt and take his medication, and watch his diet, he will invariably require hospitalization again when his condition deteriorates. This is the dilemma of ACO's. There is very little they can do to keep some patients "healthy" as defined by lessening their need of additional outpatient or inpatient services. The effort needs to be put into prevention at a much earlier stage in people's lives, before they ever get to the ACO. The way I see it, ACO's are merely gambling with numbers of various patient groups, and the more sick their demographic is, the less likely they are going to save the system any money, and less likely to remain profitable themselves. The only way they can remain viable is to not admit patients to their organization with high utilization needs, so risk reduction for the ACO becomes necessarily focused upon patient selection. In science, we would call this "selection bias" if we were doing a scientific study.
What are we going to measure? How are we going to measure it? How are we going to use the data to improve conditions for providers and patients? These are the questions IT needs to be asking.
And for organizations currently working with EMR implementation and adoption, they need to be tracking data that will be meaningful to themselves and others who are not as far along the in the EMR adoption process. What can we learn from non-biased data gathering, from different hospital systems and HCO's who have adopted EMR? How long does productivity at the physician office level actually suffer? How has this impacted the system financially? How has it impacted patient wait times to get an appointment, or their hospitalization rates? (for chronically ill patients). These are the questions I find myself wanting answers to.
Anyway, thank you for writing a provocative article. Perhaps CMS has data on some of my questions, or there is some book or online source of information you can point me to to answer some of them. And perhaps I have given you some ideas for future articles that you can write, too. Thank you for making me think about it.