EHRs & HIEs Enable Care Coordination and Improve Patient Outcomes at Brookdale University Hospital

The Brookdale University Hospital and Medical Center is one of New York’s most innovative hospitals on the forefront of health IT. As one of Brooklyn’s largest voluntary nonprofit teaching hospitals with 530 inpatient beds and a regional tertiary care center, Brookdale provides general and specialized inpatient care to hundreds of thousands of people every year. In addition, the medical center provides 24-hour emergency services, numerous outpatient programs, and long-term specialty care. Brookdale is one of Brooklyn’s largest, and most experienced full-service emergency departments and a regionally recognized Level I Trauma Center that receives more than 100,000 visits a year.

Brookdale University Hospital and Medical Center has come to rely on two main resources to seamlessly and securely access patient data and medical history.  

Brooklyn Health Information Exchange (BHIX) is a Regional Health Information Organization (RHIO) devoted to developing, deploying, operating and promoting innovative uses of health information technology to facilitate patient-centric care in Brooklyn and surrounding areas. BHIX was established in 2007 as a community-driven collaboration between providers and payers interested in improving patient care across healthcare settings.

RHIOs, such as BHIX, maintain medical records that are continually updated by participating healthcare providers, who can then access the accumulated data with a patient’s consent.

As one of the largest and busiest full-service emergency departments in Brooklyn and a regionally recognized Level I Trauma Center with more than 100,000 visits a year, Brookdale University Hospital and Medical Center has a demonstrable need to instantly and securely access accurate patient data from a multitude of sources. In an emergency situation, access to critical patient data such as medical history, medication usage, and allergies can often make the difference between life and death.

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Report Finds Paper-Based Strategies Still a Critical Element to Successful Healthcare Information Exchange

HIMSS Analytics recently released a new report on the barriers, challenges and opportunities of healthcare information exchange (HIE). The report, sponsored by ASG, examines the current state of information exchange among U.S. hospitals and explores the opportunities for improving the collection and exchange of patient data.

Survey respondents – 157 senior hospital information technology (IT) executives – indicated that there are two major challenges in the collection and sharing of patient information despite high levels of HIE participation:

More than 70 percent of respondents reported that their organization was part of a HIO, meaning that they participate in HIE with other hospitals and health systems. Approximately half of those respondents also reported improved access to patient information. However, the benefit did not result in robust data sharing, as 49 percent of the respondents cited this as the primary challenge to sharing patient information.

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Why Are Doctors Still Hesitant in Utilizing EHRs?

Parker
Parker

Guest post by Scott Parker, Cure MD.

Despite the government doling out billions for the advancement of healthcare information technology (HIT) through the electronic health record (EHR) Medicare and Medicaid incentive programs, the shift toward adoption of EHR has not picked up as rapidly as expected.

A deeper study into the issue reveals that physicians and healthcare providers, who are normally at ease in incorporating cutting edge technology into their work, are facing a plethora of problems because of the government’s incentive programs. A hasty implementation of certified EHR, which were provided by hundreds of vendors, resulted in physicians buying tools that were not optimized to meet a individual user’s needs. As a result, instead of facilitating providers, these tools have had a negative impact on their workflows, decreasing efficiency.

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Preparing for Coordinated Care: An HIT Framework

Preparing for Coordinated Care: An HIT Framework
Battani

Guest post by Jordan Battani, managing director of CSC’s Global Institute for Emerging Healthcare Practices.

There’s a sea change underway in healthcare in the United States, an effort that’s focused on addressing the challenge to improve healthcare quality and outcomes for patients and the population at large, while at the same time controlling and reducing healthcare cost inflation. It’s no small task, and there is no shortage of opinions about how best to make the changes that will be required.

At the core of the discussions, however, is a general understanding that a fundamental change in the traditional orientation to healthcare, and healthcare financing is required. Episode focused, fee-for-service medicine has led to a systematic bias against coordination and collaboration.

The need for change is particularly acute in a world that is increasingly defined not by acute episodes of illness and injury, but by the constant demands placed by the burden of managing the impact of chronic disease. Transformation requires an expansion from the traditional focus on patients and episodes to include populations and the entire care journey experience from wellness, through illness and back again.

In short, an expansion:

The core competency in this new orientation is the ability to practice coordinated care and to manage the financial arrangements that support it. Medicare, and many commercial health plans, refer to this competency as “accountable care.”

Practicing in this new environment requires the ability to expand care beyond the traditional boundaries of a linear provider to patient interaction during a discrete episode of acute illness or injury. In a healthcare landscape characterized by long-term chronic disease, healthcare must include the patient’s lifestyle, environment and long-term personal health risk factors in care planning, delivery and management.

Delivering that care plan cost effectively using complex clinical technologies and innovations requires coordinating and integrating the activities and information from multiple care settings and many different providers. Financing a coordinated care delivery system requires expanding payment for activities beyond fees for the services rendered for a discrete episode to include compensation for the effort and the value delivered from collaboration, coordination and integration across the continuum of settings and providers.

Not surprisingly, the tools and capabilities required for practicing in the era of coordinated care are more complex and far reaching than those required in the traditional episode-based fee-for-service model.

Successful coordinated care requires:

In an environment characterized by multiple, conflicting and interlocking mandates and transformation requirements it’s a difficult task to take on a new set of organizational and technology strategies, and tempting to focus instead on meeting the deadlines and details of the individual programs and requirements.

There is no single road map to success and the timeline, priorities and projects for each organization will vary based on their circumstances. The only certainty is that under the current set of clinical quality, patient safety and financial pressures and requirements, organizations that fail to develop and demonstrate coordinated care capability risk long-term clinical and financial failure.

Jordan Battani is the managing director for CSC’s Global Institute for Emerging Healthcare Practices, the applied research arm of CSC’s Healthcare Group. Battani has a strong professional track record in leveraging technology solutions to deliver business value.

Will Healthcare Interoperability Become the Next Health IT Mandate?

Lack of healthcare interoperability continues to throw its weight in the road of progress, stopping much traffic in its tracks.

But you know that already, don’t you; you work in healthcare IT. That electronic health records lack the ability to speak with their counterpart systems is no surprise to you. In fact, it’s probably caused you a great deal of frustration since the first days of your system implementation.

From my perspective, things are not going to change very soon. There’s not enough incentive for vendors to work together, though they can and in many cases are able to do so. The problem, though, is that vendors are not sure how to charge physicians, practices, hospitals and healthcare systems for the data that is transferred through their “HIE-like” portals that would connect each company’s technology.

The purpose of this piece is not to diverge into the HIE conversation; that’s a topic for another day. However, this is a piece about what have recently been listed as the biggest barriers physicians face when dealing with the concept of interoperability.

According to a recent report by Internal Medicine News, “Technical barriers and costs are holding back electronic sharing of clinical data.”

The magazine cites a study in which more than 70 percent of the physicians said that their EHR was unable to communicate electronically with other systems. This is the definition of a lack of interoperability that prevents electronic exchange of information, and ultimately will fuel health information exchanges.

It is notable that 30 percent of physicians said that their EHRs are interoperable with other systems. That makes me wonder if this is a verified fact or perception only verified by a marketing brochure.

Another barrier, according to the report, is the cost of setting up and maintaining interfaces and exchanges to share information. According to this statement, physicians are worried about the cost of being able to transmit data, too, which puts them in line with vendors, who, like I said, are worried about how they can monetize data transfer.

An interesting observation from the piece: “Making progress on interoperability will be essential as physicians move forward with different care delivery models such as the patient-centered medical home and the medical home neighborhood.”

What amazes me about this conversation is that given the purported advantage employees gain from the mobile device movement and how BYOD (bring your own device) seems to increase a staff’s productivity because it creates an always-on mentality. I don’t think it’s a stretch to think the same affect would be discovered if systems were connected and interoperable.

An interoperable landscape of all EHRs would allow physicians and healthcare systems to essentially create their own always on, always available information sharing system that would look a lot like what we see in daily lives with the devices in the palm of our hands.

Apparently, everyone wants and interoperable system; it’s just a matter of how it’s going to get paid for. And moving the data and the records freely from location to location opens up the health landscape like a mobile environment does.

Simply put, this is one issue that seems to resemble our current political landscape: a hot button issue that needs to be addressed but neither side wants to touch the issue because no one wants to or is able to pay for it.

One of the problems with this approach is that if we wait long enough, perhaps interoperability also will be mandated and we’ll all end up on its hook.

So, let’s take a lesson from the mobile deice world and allow for a greater opportunity to connect healthcare data to more care providers on behalf of the patients and their outcomes.

IDC Health Insights’ Judy Hanover on the Need for Structured Data, and the Long-term Affects of Health IT Reform

Judy Hanover, Research Director of IDC Health Insights

As health IT continues to mature and providers continue to adopt technologies like electronic health records, the data collected from their use in the care setting becomes the most obvious reason so much energy is being put behind getting practices to implement the systems.

Judy Hanover, research director of IDC Health Insights, recently told me, though, that one of the biggest challenges faced by ambulatory and hospital leaders is that the data entering the electronic systems, in most cases, is unstructured, which makes it almost useless from an analytics standpoint.

Without structured data, Hanover said, quantitative analysis across the population can be complicated, and little can be compared to gain an accurate picture of what’s actually taking place in the market. Without structured data, analytics is greatly compromised, and the information gained can only be analyzed from a single, siloed location.

“There must be synergy between the data collected,” Hanover said. “We’re entering the period of structured data where we’re now seeing the benefits of structured data but still need to manage unstructured data.”

In many cases, critical elements of data collected — like medications, vitals, allergies and health condition — are difficult to reconcile between multiple data sources, reducing the quality of the data, she said. Unstructured data proves less useful for tracking care outcomes of a population’s health with traditional analytics.

For example, tax information and census data are collected the same way across their respective spectrums. All the fields in their respective fields are the same and can be measured against each other. This is not the case with the data entering an EHR. Each practice, and even each user of the system, potentially may collect data differently in a manner that’s most comfortable to the person entering the data. And as long as practices continue to forgo establishing official policies for data entry and requiring data to be entered according to a structured model, the quality of the information going in it will be a reflection of the data coming out.

Lack of quality going in means lack of quality coming out.

“In many cases, structured data is not as useful for analytics as we’d hoped,” Hanover said. “There are inconsistencies in the fields of data being entered in to the systems; and that affect data quality as well as results from analytics.

“As we move into the post EHR era, how we choose to leverage the data collected is what will matter,” she said. “We’ll examine cost outcomes, optimize the setting of care and view the technology’s impact.”

As foundational technology, EHRs are allowing for the creation of meaningful use, but once the reform is fully in place, the shift will focus on analytics, outcomes and benefits of care provided.

Currently electronic health records define healthcare, but health information exchanges (HIE) will cause a dramatic shift in the market leading to further automation of the providing care and will change how location-based services and clinical decision making are viewed.

Though some practices are clearly leveraging their current data, others are not. For them, EHRs are nothing more than a computer system that replaced their paper records and qualified them for incentives.

In the very near term, the technology will have to have more capability than simply serving as a repository for information collected, but will become a database of reference material that will have to be drawn upon rather than simply housed.

“Health reform is the end game,” Hanover said. “And there can be no successful reform without EHRs. They are the foundational technology for accountable care.”

The data collected in this manner will lead to a stronger accountable care model, which will once again bring the practice of care in connection with the payment of care.

Evidence-based approaches will continue to dominate care when the data suggests certain protocols require it, which means insurers will feel as though they are working to control costs.

Unfortunately, all of the regulation comes at an obvious cost at the expense of the technology and its vendors, said Hanover. EHR innovation continues to suffer with the aggressive push for reform through meaningful use as vendors scramble to keep up with requirements.

“There’s little or no innovation because all of the vendors are being hemmed down by meaningful use and certification requirements,” she said.

Product standardization means there are far fewer products that actually stand out in the market.

More innovation will likely only come following market consolidation in which only the strong will survive. Hanover suggests that in this scenario, survivors will focus on innovative product research and development and will take a leadership role in moving the market forward

Though vendors will suffer, users of the systems will likely face major set backs and upheavals at the market shifts and settles. Especially as consolidation occurs, suppliers disappear or change ownership, practices and physicians using these systems face the toughest road as they’ll be forced to find new solutions to meet their needs, learn the systems and try to get back to where they were in a meaningful way in a relatively short period of time.

Likely, deciding which system to implement may bear just as much weight as deciding how to use it.