Electronic Health Reporter

Health IT’s most pressing issues may be so prevalent that they can’t be contained to a single post, as is obvious here, the fourth installment in the series detailing some of the biggest IT issues. There are differing opinions as to what the most important issues are, but there are many clear and overwhelming problems for the sector. Data, security, interoperability and compliance are some of the more obvious, according to the following experts, but those are not all, as you likely know and we’ll continue to see.

Here, we continue to offer the perspective of some of healthcare’s insiders who offer their opinions on health IT’s greatest problems and where we should be spending a good deal, if not most, of our focus. If you’d like to read other installments in the series, go here: Health IT’s Most Pressing Issues, Health IT’s Most Pressing Issues (Part 2) and Health IT’s Most Pressing Issues (Part 3). Also, feel free to let us know if you agree with the following, or add what you think are some of the sector’s biggest boondoggles.

Charles A. “Drew” Settles, product analyst, TechnologyAdvice

First and foremost, of all the issues facing healthcare technology, I believe the top issue is the interoperability (or lack thereof) of most electronic medical records systems. Interfacing systems from disparate vendors usually takes expensive custom development, but hopefully the push for free access to EMR/EHR APIs in Stage 3 of the Meaningful Use Incentive program will finally bring semantic interoperability to health IT.

Paul Cioni, senior vice president, Healthcare & Infor Solutions Sales, Velocity Technology Solutions
The top issue facing healthcare CIOs is that there is simply too much for them to do, including major initiatives involving information security, patient confidentiality, and revenue cycle management and reimbursement. Most are focusing on what’s urgent, rather than on what’s important. All of these issues are not only competing for a CIO’s budget, but also for his/her time. With so many things on the “as soon as possible” priority list, healthcare CIOs barely have time to strategically plan. It’s difficult for CIOs to create a five-year plan for the organization’s IT when they’re trying to figure out the next five months. A disaster recovery plan, for example, may not get created when CIOs are more concerned with downtime of clinical applications or the reporting of a data breach to the regulatory authorities.

The use of the cloud — with a comprehensive but flexible portfolio of service options- helps relieve CIOs from what I call the “tyranny of the urgent.” By allowing a cloud provider to manage a variety of back-office and ERP-related functions, the CIO can shift his focus to systems that affect clinical outcomes. Extending the secure, private cloud approach to clinical systems liberates key resources — budget and people — to focus on achieving meaningful use or embracing population health initiatives. Cloud deployment options like disaster recovery as a service or desktop as a service can conserve capital dollars and speed time to outcome. It’s not one issue – it’s all of them.

Lynn O’Connor Vos, CEO, Grey Healthcare Group (ghg):
The rapid acceleration of advancements in health information technology is leading to greater efficiency and productivity in the industry. At the same time, while technology has improved healthcare delivery in certain respects, significant challenges remain, particularly in areas related to the collection and transfer of health information and the user experience of healthcare providers and patients throughout this process. A perfect example of this is EHR/e-Prescribe systems, which are being adopted to solve a number of problems, including inaccurate prescriptions and portability of patient data, but which have also introduced other issues, in that healthcare providers (HCPs) are now burdened with time-consuming data entry that may be impacting their efficiency with chart updates.

With the goal of improving outcomes, patient adherence to medication is a critical factor in achieving the outcomes needed in chronic disease. At present, paper prescriptions leave too much to chance and it is well known that a significant number of prescriptions never get filled, and about six out of 10 patients report that they do not always take their medication as directed (according to the American Academy of Family Physicians). Health IT can play a vital role in supporting the healthcare process at every stage of a patient’s journey. However, true, efficient interoperability between healthcare systems is still a goal, rather than a reality, and immediate solutions are required to meet the needs of patients, caregivers, their healthcare providers and other stakeholders. A relevant example of this is the process of filling a prescription. As payers make efforts to control costs in the marketplace, an increasing number of prescriptions now require prior authorization (PA). Incredibly, even with the latest advancements in health IT, a patient generally doesn’t learn that their prescription has been rejected because of a PA requirement until they are standing at the pharmacy attempting to pick it up. The subsequent process to obtain a completed PA and successful submission is labyrinthine, and unfortunately, a number of drop off points exist, leading to a significant gap between PAs required and PAs successfully submitted. According to market research, upwards of 40 percent of patients who receive a PA forego treatment altogether, and only 30 percent of patients receiving a PA receive the originally prescribed medication. These data indicate that significant barriers to care exist as patients denied prescriptions at the pharmacy as a result of PA requirement are less likely to get that prescription filled at all.

Given the barriers with PAs, services have emerged to facilitate the process and attempt to improve the outcome. The challenge is that the complexity of forms and information required and the submission process itself present obstacles that are often difficult for busy healthcare providers to overcome. Administrative and logistical barriers include failure to notify the HCP about the PA requirement, incorrect form submission, submission of incomplete or inaccurate information, and confusion in completing a non-standard form. Numerous handoffs along the way also increase the likelihood that the form may never be successfully completed or submitted. To date, Health IT has not provided a seamless solution to these challenges.

The administrative onus for PAs falls heavily on physicians and pharmacies, and can bring significant effort and frustration for them. It can take an average of 30 to 45 minutes to complete a prior authorization, while denial rates can be high, often because of minor errors and omissions, and appeal processes can be cumbersome. In an environment that increasingly aligns health outcomes to reimbursement rates, unsuccessful prior authorization submissions can result in fewer patients receiving the medicine they need, poor outcomes and lost revenue. Fortunately, the prior authorization process does not have to rely solely on technology and automation. PARx Solutions provides a concierge approach to the problem, engaging clinical staff to work one-on-one with physician offices and pharmacies to help streamline prior authorization processes and improve success rates. The company’s holistic solution, which combines automated software systems with clinical staff attention and follow through, ensures a higher success rate of submission than wholly automated solutions.

Health IT has come a long way in automating many important healthcare processes; however, instant data exchange and true interoperability are still future goals, and meeting the user experience needs of healthcare constituents is still a significant challenge. Healthcare stakeholders must focus on providing immediate solutions to bridge these gaps, and some of these may require a combination of technology and human attention. To become a true service industry, healthcare must provide patients with personalized care, not systematic care. For some, this may include tangible incentives to keep to care plans, such as reduced monthly contributions to individual’s health plans by agreeing to certain commitments. For others, it may be decision-making support. Regardless of the approach, the challenge for health IT is to better support physicians and patients in more personalized ways that allow them the flexibility to drive the health care needs of each patient effectively.

Eric Rice, chief technology officer, Mach7 Technologies
Many of the current Health IT issues are around interoperability and the ability to provide a “complete” patient record. The majority of HIT systems don’t communicate with one another effectively, if at all. A single unified platform upon which to plug in best-of-breed or specialty/departmental solutions can enable communication across an enterprise, IDN or region, consolidating storage of the data.

Key issues:

— Achieving MU 2 and 3, image enabling the EMR
— Providing access and sharing of patient imaging data across the enterprise, IDN, region
— Ability for providers and clinicians to select their best-of-breed visualization solutions
— Consolidating storage / controlling storage cost
— No system in place to effectively and efficiently manage growth (i.e. organic, M&A…); need a scalable, highly-available platform

John Matthews, CIO, ExtraHop

Healthcare IT organizations are being bombarded from all sides. Not only are they tasked with managing complex, diverse and disparate IT environments of any industry, they must often do so on a budget and with limited human capital. Compounding these pressures is the fact that clinicians and business stakeholders rely heavily on IT systems to manage patient care and outcomes.

Take the ICD-10 migration, for example. Working with our customers, we’ve realized that one of the foundational challenges of this migration has simply been the ability to quickly and easily identify the components in their environment that interact with ICD codes. HDOs need this information in order to understand how these codes flow through the organization, and to develop a roadmap for migration. Incomplete migration when the new standards go into effect on October 1 of this year will have a major impact on the business side of healthcare, impacting billing and reimbursement. It will also impact patient care if patient conditions are improperly coded, making it more difficult to provide proper care and deliver good outcomes.