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Recognizing Value In and
Realizing Value From Health
InformationTechnology
Authors: Joan McQueen, Angela Robinson, Rebekah Ruyts, Pam Shirley and Tak Tang
Topics Covered
• Recognizing Value In Health Information Technology (HIT)
– History– Benefits and Risks– Electronic Health Records– Personal Health Records– E-Prescribing– Health Information Exchange– Telemedicine– Wireless Technology
Topics Covered (cont’d)
• Realizing Value From Health Information Technology (HIT)
– Benefits Measurement Program– ROI (Return on Investment) vs. Value
• New Capabilities in Health Information Technology (HIT)
– Electronic Health Records (EHRs)– Computer/robotic solutions– Public service aspects of Health Information
Exchanges (HIEs)
Recent history of HIT:
The Institute of Medicine’s (2001) call for the use of electronic prescribing systems in all healthcare organizations by 2010 heightened the urgency to accelerate United States hospitals’ adoption of Computerized Physician Order Entry (CPOE) systems.
In 2004, President Bush signed an Executive Order titled the President’s Health Information Technology Plan, establishing a ten-year plan as this technology is essential to put the needs and the values of the patients first and gives patients information they need to make clinical and economic decisions.
Recognizing Value in HIT
With healthcare costs and quality assurance taking priority
in patient care, increased attention has been focused
towards the potential of HIT to lower health care
expenses, improve efficiency, quality, and safety of
healthcare delivery.
Some of those improvements include:
Electronic Health Records Personal Health Records E-Prescribing Health Information Exchange
Recognizing Value in HIT
According to the Health and Human Services Recovery Program:
“Recovery funding has been designated to
modernize the health care system by promoting and
expanding the adoption of health information
technology by 2014. Achieving this goal will reduce
health costs for the federal government by over $12
billion over the next 10 years.”
-From HHS.GOV
Recognizing Value in HIT
General benefits of HIT
•Elimination of chart-pulling, chart-filing, chart loss.
•Easy electronic review of patient information before visits.
•Notification of completed diagnostics and labs to review.
•Notification of required follow-ups, tests, etc.
•Improved timeliness of care team communications.
Recognizing Value in HIT
General benefits of HIT (cont’d)
•Potential reduction in medical errors with decision support systems and easier access to relevant information
•Reduction in prescription errors and subsequent time lost communicating with pharmacies.
•Reduction of adverse drug reaction/ interactions via immediate access to drug-drug and drug-food interaction alerts.
Recognizing Value in HIT
General benefits of HIT (cont’d)
•Easy communication with patients’ other providers, specialists, hospital visits, etc.
•More complete and detailed information available for claims, malpractice suits, etc.
•Potential reduced costs for labor and supplies related to charts and chart maintenance.
•Improved flow of information between staff members.
Recognizing Value in HIT
General risks of HIT
•Workflow disruption. Decreased productivity.
•Costly set-up and costly maintenance.
•Lack of adequate funding can jeopardize completion of projects.
•Low technological competence among staff — problems with adjustment, fear of change.
Recognizing Value in HIT
General risks of HIT (cont’d)
•Perceived unhappiness among patient population — “you talk to the computer, not me.”
•Technical limits in your practice (no high-speed connection, etc.).
•Chosen Health IT product doesn't adequately fit needs (e.g., have to double-document or sustain paper-based processes and electronic processes).
Recognizing Value in HIT
Electronic Health Records
Recognizing Value in HIT
“The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting.”
--HIMSS, 2009
Personal Health Records
Recognizing Value in HIT
“The PHR is a tool that you can use to collect, track and share past and current information about your health or the health of someone in your care. Sometimes this information can save you the money and inconvenience of repeating routine medical tests. Even when routine procedures do need to be repeated, your PHR can give medical care providers more insight into your personal health story.”
-myPHR.com
Personal Health Records (cont’d)
Recognizing Value in HIT
Important points to remember about a Personal Health Record:
•PHRs are owned and updated by the healthcare consumer, not the provider. The information can be electronically shared with care providers as the consumer has determined it’s usefulness to their care.
•You should always have access to your complete health information.
Personal Health Records (cont’d)
Important points to remember about a Personal Health Record:
•Information in your PHR should be accurate, reliable, and complete.
•You should have control over how your health information is accessed, used, and disclosed.
•A PHR may be separate from and does not normally replace the legal medical record of any provider.
Recognizing Value in HIT
E-Prescribing
More than an electronic medium, e-Prescribing improves the management of patient drug histories and provides immediate access to decision-support information at the point of care delivery. It accomplishes this by:
• Eliminates handwriting issues.
• Creates electronic records to ensure prescription information is not lost.
Recognizing Value in HIT
E-Prescribing (cont’d)
•Improves data exchange between prescribers and pharmacists.
• Expedites prescription refill requests and medication delivery.
• Reduces costs by improving work efficiency and identifying less expensive drug options.
Recognizing Value in HIT
E-Prescribing (cont’d)
• Checks for allergies, drug-drug interactions, dosing errors, therapeutic duplication, pregnancy-related issues and other patient-specific factors.
• Maintains an accurate, comprehensive drug database.
• Provides up-to-date formulary and insurance information.
Recognizing Value in HIT
Health Information Exchange (HIE)
The terms “RHIO” and “Health Information
Exchange” or “HIE” are often used interchangeably.
RHIO (regional health information organization) are
a group of organizations with a business stake in
improving the quality, safety and efficiency of
healthcare delivery.
Recognizing Value in HIT
Health Information Exchange (HIE) (cont’d)
The goal of HIE is to:
•Facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care.
•HIEs also provide the infrastructure for secondary use of clinical data for purposes such as public health, clinical, biomedical, and consumer health informatics research, as well as institution and provider quality assessment and improvement.
Recognizing Value in HIT
Recognizing Value in HITTelemedicine
A general term used to describe the ability of
telecommunication and technology to be used for
consulting or remote patient care.
Telemedicine is being used in a variety of medical
related areas such as radiology, cardiology, surgery,
home health and oncology.
Recognizing Value in HITTelemedicine (cont’d)
Uses for Telemedicine:• video-conferencing• dispensing medications• blood pressure checks• glucose monitoring• ECG on demand • wound care• updated treatment plans • allows physicians to consult on various procedures from different countries
Recognizing Value in HIT
Wireless Technology: Benefits
• Advances in wireless technology have become important tools in HIT
• Wireless technology allows for formerly stationary IT systems to become mobile via cellular and WiFi connections
• Allows improved accessibility to areas of hospitals previously not accessible (e.g. OR)
Recognizing Value in HIT
Wireless Technology: Benefits (cont’d)
• Allows real time communications which can lead to improvement in care team interactions
• Can increase patient safety and improve patient care through workflow improvements
Recognizing Value in HIT
Wireless Technology: Limitations
• Reliability variances
• Accessibility variances
• Lack of standards for coverage and speed in areas of hospitals
• Cost/budgetary constraints/lack of funding sources
Recognizing Value in HIT
Implementation of Wireless Technology
Requires:
• Thorough site surveys to ensure in areas of installation that wireless signals will be accessible and reliable in the targeted area of use.
• Site survey should be done before a design plan is developed and implemented.
Recognizing Value in HIT
Implementation of Wireless Technology (cont’d)
Requires:
• Evaluation of organizational needs to ensure proper wireless infrastructure will meet established needs-current and future.
• A well planned wireless infrastructure can accept new technologies with only minimal changes to the current design.
Realizing Value from HIT
Benefits Measurement Program
Realizing value from HIT is not always easy, either in
measurement or assessment. Traditionally, the Return
on Investment (ROI) model has been the standard for
determining whether a new process, piece of
equipment or technology is value-added to an
organization. Realizing value has, for the most part,
been seen in terms of bottom-line cost reductions.
Realizing Value from HIT
Benefits Measurement Program (cont’d)
However, measuring the value from HIT is not that
cut and dry. Other models for realizing value need
to be employed in organizations who have or will
adopt HIT applications.
Realizing Value from HITBenefits Measurement Program (cont’d)
One approach to realizing value from HIT is by
implementing a benefits measurement program. In
their article “Measuring IT Benefits: Let Us Count
the Ways", David Greenwalt and Steven Riney
suggest that there are four steps to this approach.
Realizing Value from HITBenefits Measurement Program (cont’d)
•Identifying benefits and metrics prior to project funding or approval
•Determining baseline measurements
•Performing a benefits opportunity analysis
•Performing a post-implementation benefits audit
Realizing Value from HITBenefits Measurement Program (cont’d)
First, the key benefits the organization expects to
achieve from implementing the new solution and
which metrics will best determine whether the
project has met its goals should be identified. The
benefits should be those that most closely represent
the organizations strategic direction. Ideally, there
should not be more than 12 identified benefits for
which effectiveness is measured.
Realizing Value from HIT
Benefits Measurement Program (cont’d)
Once the benefits and metrics have been identified,
a baseline for each metric needs to be calculated.
Clarifying the definitions and calculations of each
metric while determining the baseline will be useful
in mitigating discussions post implementation during
the benefits realization phase.
Realizing Value from HIT
Benefits Measurement Program (cont’d)
In performing a Benefits Opportunity Analysis, one
should look to established best practices, however,
in reality, there are few standards for best practices.
To determine the opportunity for achieving any
individual benefit, and organization should do four
things.
Realizing Value from HIT
Benefits Measurement Program (cont’d)
•Identify any national standards or benchmarks.
•Review any published studies by similar organizations.
•Evaluate the methods used to obtain these results.
•Balance these factors with the organization's own culture and capability.
Realizing Value from HIT
Benefits Measurement Program (cont’d)
Finally, a post implementation benefits audit needs
to be conducted. This is probably the most critical
step in assessing IT implementations, as the real
value in building a plan is measuring against it and
learning from the differences.
Realizing Value from HIT
Benefits Measurement Program (cont’d)
These authors also propose that the three main reasons IT-related investments fail to deliver value are as follows:
•Poor alignment of processes and technology
•Inadequate process change
•A lack of executive ownership and accountability
Realizing Value from HIT
ROI (Return on Investment) vs. Value
• Focus on “Value” instead of ROI.
• True “Value” can be recognized by an organization if a change to an integrated leadership model is made.
• Integrated leadership involves collaboration among IT professionals, clinical professionals and financial officers.
Realizing Value from HIT
ROI (Return on Investment) vs. Value (cont’d)
• Involves a common goal and a willingness of all parties to listen to each others’ perspectives.
• Power struggles need to be left at the door and joint decisions need to be made for the good of the organization.
• Needs to be a proactive process instead of a reactive process.
New Capabilities in Health Information Technology (HIT)
Electronic Health RecordsAdvances in EHR applications extend the depth and
breadth of record keeping by having the ability to store:
• Email• Voicemail• Scanned Images• Recorded interviews, which is especially helpful in
mental health• Patient photos (before and after)
New Capabilities in Health Information Technology (HIT)
Telemedicine
Advances in telemedicine applications extend the
physician’s capabilities through computer/robotic
solutions.
This is particularly exciting for parts of the country
that can’t attract or retain highly trained specialists
due to lack of population and/or advanced
facilities.
New Capabilities in Health Information Technology (HIT)
Health Information Exchanges (HIEs)
Development and expansion of HIEs will do much to
serve the public good in the following ways:
• Tracking drug seeking activity
• Identifying and tracking child abuse
• Identifying infections by monitoring patient data
Conclusion
As can be seen from the previous slides, there are a
variety of ways to recognize value in and realize
value from health information technology.
Advances in these fields will also offer new
opportunities for advancing patient care. This field
will continue to grow and advance, especially with
incentives such as those included in the ARRA of
2009.
Conclusion (cont’d)
Other businesses and industries are far ahead of the
healthcare industry in terms of IT adoption, and
there is a need to bring healthcare into the 21st
century. If one looks at healthcare in its most
fundamental form, it is an “information” business,
so recognizing the value in and realizing the value
from HIT is critical as we move forward with
healthcare reform in the United States and
globally.
REFERENCES
Agency for Healthcare Research and Quality (2006). Costs and Benefits of Health Information Technology. Retrieved on November 10, 2009. Link available at http://www.ahrq.gov/downloads/pub/evidence/pdf/hitsyscosts/hitsys.pdf.
AMA (2009). Risks and Benefits of Health Information Technology (Health IT). Retrieved on November 10, 2009. Link available at http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/health-information-technology/putting-hit-practice/selecting-hit/risks-benefits-hit.shtml.
Ankerstjerne, W. D., & Rehman, M. (2009). Wireless technologies. In Health Informatics Series: Anesthesia Informatics, Springer: NY, pp. 425-436
Arlotto, P., et al. (2007). Chapter 2-Healthcare information technology as a strategic asset: A framework for value management. In Arlotto, P., Birch, P. C., Crockett, M. H., Irby, S. P., (2007). Beyond return on investment: Expanding the value of healthcare information technology. Chicago, IL: Healthcare Information and Management Systems Society, pp. 7-14.
Greenwalt, D., Riney S. (2007). Measuring IT benefits: let us count the ways. Healthcare Financial Management, 61(2), pp. 86-92.
Healthcare Information and Management Systems Society (2009). Electronic Health Record. Retrieved on November 10, 2009. Link available at http://www.himss.org/ASP/topics_ehr.asp.
Healthcare Information and Management Systems Society (2009). HIMSS Health Information Exchange (HIE). Retrieved on November 10, 2009. Link available at http://www.himss.org/asp/topics_rhio.asp.
Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., and Taylor, R. (2005). Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs, 24(5), pp. 1103-1117.
myPHR (2009). What is a PHR? Retrieved on November 10, 2009. Link available at http://www.myphr.com/index.php/start_a_phr/what_is_a_phr/.
REFERENCES
National ePrescribing Patient Safety Initiative (2009). FREE electronic prescribing…for every physician in America. Retrieved on November 10, 2009. Link available at http://www.nationalerx.com/.
Telemedicine.com: http://www.telemedicine.com/whatis.html
U.S. Department of Health and Human Services (2004). HHS Fact Sheet--HIT Report At-A-Glance. Retrieved on November 10, 2009. Link available at http://www.hhs.gov/news/press/2004pres/20040721.html.
U.S. Department of Health and Human Services (2009). Recovery Programs: Health Information Technology (HIT). Retrieved on November 10, 2009. Link available at http://www.hhs.gov/recovery/programs/index.html#Health.