U.S. Playing Catch Up in Health Care IT

By Darryl K. Taft  |  Posted 2007-08-14

U.S. Playing Catch Up in Health Care IT



.S. Playing Catch Up in Health Care IT">Health care IT in the U.S. lags behind that of many other countries, such as Denmark and New Zealand, but the prognosis is for gradual improvement if the country continues a steady regimen of investment and development.

Dr. Paul Grundy, director of health-care technology and strategic initiatives at IBM Corp. in Armonk, N.Y., said the U.S. HIT (Health Information Technology) system is fragmented but is slowly progressing.

Grundy, who is a physician and a founding member of the Patient Centered Primary Care Collaborative, said, "I think were making some progress, but weve got a long ways to go."

Grundy said he spoke at a medical advisory counsel meeting in Washington on Aug. 6 where the issues of HIT were prominent among the 10 largest companies buying health care for their employees.

"What we really want in terms of the state of HIT is to enable improvements in collaboration and practice-based quality improvements," Grundy said. "We want providers to be able to utilize registries" and electronic records, he added.

Moreover, electronic records drive transformation and change in the system, fosters closer doctor/patient relationships and enables doctors to engage patients more easily, Grundy said.

Steve Shihadeh, GM sales, marketing and partners for Microsoft Corp.s Health Solutions Group, said the health care landscape is very complicated and often times very disjointed as hospitals and health systems, insurance and physicians, general practice physicians, and consumers all interact in a complicated ecosystem.

"The reality is that most hospitals have islands of data that cant easily be shared with other systems due to disparate data types," Shihadeh said. "Hospitals until very recently have lagged behind almost every other industry group in the percentage of revenue that is invested in IT [spending only three percent]. Thats up significantly in the last couple years. However, even hospitals at the high end of the spending curve in terms of IT investments are only doing transactional systems."

Grundy said, "We want to have the kinds of tools within the HIT infrastructure so that physicians can deliver safe medical care."

For instance, Grundy said Denmark is known for having the most advanced HIT system in the world. And on a recent trip to Denmark, Grundy said he was invited to witness a Danish doctor interacting with patients.

"The doctor had a full electronic medical record of each patient and the patient can view their medical record from home, Grundy said.

One patient came into the office and was diagnosed to need an aortic valve replacement. Using the integrated Danish HIT system, "the patient and the doctor looked at every hospital in the country that did aortic valve replacements," he said. They were able to get statistics and reviews on each facility and were able to choose one and to schedule surgery through the system.

In another instance, Grundy said a patient came to the doctor seeking a remedy for lack of sleep. The doctor filed a prescription through the HIT system with a pharmacist. Yet, before the patient left the office, the pharmacist returned a message to the doctor noting a possible relation to the patients asthma and the doctor was able to solve the patients problems by treating his asthma, Grundy said.

Moreover, in the Danish system, patients have greater access to call doctors for a fee and "patients can e-mail their doctor and the doctor gets paid for that" as well, he said.

Randall Oates, M.D., who is president of SOAPware Inc., Fayetteville, Ark., the company that sells an electronic medical record system known as SOAPware, said that what is missing from the U.S. HIT system "are patient-centered approaches to HIT. The patient has to be able to administer and monitor the exchange of their personal health information."

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SOAPware is an Electronic Health Record designed for clinics and developed with the goal of eventually replacing paper charts. SOAPware meets users where they are, on their own terms, by allowing them to continue using dictation and handwriting at the beginning, while still providing the capability to adapt and evolve into a fully digital system.

However, none of the top five hospitals has an electronic records system that connects into the community in any way, Grundy said. "Theyre siloed."

Added Grundy: "We need something portable, usable and with open standards, otherwise theres this big disconnect. The systems dont connect in any meaningful way."

Oates added, "The industry is fragmented with a lack of standards, information silos, and a near cartel approach to problem solving."

Indeed, "Health information exchange is in its infancy in the U.S.," Oates said. "The payers control a highly fragmented system where information is not shared."

In a keynote presentation at a conference entitled "Health IT Trends & Marketing: A Conference Designed for Health IT Vendors in Boston two years ago, W. Walter Wego, M.D., slammed the vendors involved in the HIT business.

"I see the HIT industry as being critical to solving some major problems my patients and I are having," Wego said. "We really need your cooperation and participation to finally solve some serious problems with health care."

He went on to say: "…does your hypocrisy have any limits? I recently wanted to interface a practice management system from one of you to an EHR [Electronic Health Record] from another vendor. When it got right down to it, you were willing to interface your PMS [Practice Management System] to the EHR, all right, and only for a measly $27,500. And, this was for just your half of the interface. On the other hand, the EHR vendor required only $500 for their half and this seemed reasonable."

Moreover, said Wego in his keynote, "I wish this practice of overcharging for interoperability was unusual, but I have been checking around with my peers and discovered it is the norm for most of you HIT vendors to charge prohibitive fees in order to provide even a crude degree of interoperability."

Grundy said he believes the most important concept for the industry to consider is "dont delay good for the best." He said the health care IT system ought to "have enough information about you that if you should land in an emergency room somewhere, they can safely treat you."

To that end, the ASTM (American Society for Testing and Materials) Internationals CCR (Continuity of Core Record) can play a part, Grundy said.

CCR was developed in response to the need to organize and make transportable a set of basic information about a patients health care that is accessible to clinicians and patients, according to the AAFP (American Academy of Family Physicians) Web site.

The CCR is intended to foster and improve continuity of care, reduce medical errors and ensure a minimum standard of secure health information transportability. Adoption of the CCR by the medical community and IT vendors will be a great step toward achieving interoperability of medical records, supporters said.

The CCR is a core dataset to be sent to the next health care provider whenever a patient is referred, transferred or otherwise uses different clinics, hospitals or other providers. And practitioners believe the CCR will prevent physicians and other health care professionals from having to act blindly, without easy access to relevant patient information.

"The real bright spot of actual progress in standards that is promising to quickly deliver some wins for docs and patients is the Continuity of Care standard from ASTM," Oates said in his own keynote address at the conference Wego also keynoted.

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The problem is not everybody has access to systems that support the CCR. SOAPware supports CCR as do other electronic health record offerings.

"Its going to be the presence of affordable electronic medical record systems in the marketplace that is going to drive uptake" of things like the CCR, Grundy said.

Meanwhile, a recent Commonwealth Fund/Modern Health care survey showed that 66 percent of 214 health care policy leaders surveyed said they think that rapid adoption of electronic health records and other IT systems is of primary importance. And 70 percent of the respondents said they think the federal government should play a leading role in backing providers IT investments.

In May, IBM pledged to dedicate its influence, technologies, services and knowledge base to help the PCPCC (Patient Centered Primary Care Collaborative)—the emerging consortium of employers, physicians and consumer groups that Grundy co-founded with Dr. Martin Sepulveda, IBM vice president, Global Well-being Services & Health Benefits—win its fight to revolutionize Americas ailing health care system.

Among its many initiatives, the PCPCC is pushing the use of Electronic Patient Health records and Web portals to connect patients to their own data, allow communication with PCPs (primary care physicians), renew their prescriptions and review information concerning their overall health situations. Such Web-based systems have driven scores of millions in savings in nations like Denmark, systems like the Veterans Administration and Medicaid in states like North Carolina, Grundy said.

"Were really a long ways behind [many other countries in health care IT] in many, many ways, with some exceptions like the VA [Veterans Administration]," Grundy said. "But in terms of my ability to buy health care across the country with connections and interoperability, were behind."

The PCPCC to date represents employers of some 50 million people across the United States as well as physician groups representing some 330,000 medical doctors. And the group is working to effect change, but it is gradual.

In the United States, the health care industry is a $2 trillion dollar industry, with more than $100 billion spent on IT, researchers estimate. And health care IT spending is forecasted to grow at near double digit rates for the next decade, some say. For the United States, this represents 16 percent of GDP with annual increase projected at 7.7 percent through 2010. The largest health care provider in the United States is the federal government.

In a study entitled "Behind the Numbers: Health Care Cost Trends for 2008," PricewaterhouseCoopers analysts said: The deceleration in the medical cost trend is influenced by a number of short- and long-term factors. For 2008, our research has identified those factors as: Slower spending growth for prescription drugs; increased transparency and cost sharing with employees; total-health-management approach to benefits; and broadening of the digital backbone in health care."

The study by PricewaterhouseCoopers Health Research Institute, said, "The digital backbone that connects health providers, payers, and vendors is expanding. Connecting the health system electronically will aid payers in better managing both performance and compliance throughout the continuum of care."

For example, widespread adoption of electronic medical records and other health information technology is estimated to save $162 billion a year by improving care management, reducing preventable medical errors, lowering death rates from chronic disease and reducing the number of employee sick days, the Pricewaterhouse Coopers study said.

Yet, "Making the digital backbone a reality stems from progress on two issues that have long been cited as barriers to health IT adoption: lack of national standards and interoperability," the PwC study said.

Finally, the PwC study concludes: "While still in its early stages, the potential to improve quality and reduce variation in provider practice patterns will be strengthened as the digital backbone continues to strengthen."

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Microsofts Shihadeh said there have been great investments and improvements in HIT, "but rarely, if ever, have health systems been able to tie together all of their information sources. For years weve heard people in health care asking, Now that we have all this data, how can we use it to do a better job?"

Shihadeh said Microsofts Azyxxi is the answer to that question. Microsoft acquired the Azyxxi technology a year ago. It is an enterprise-wide clinical and financial data warehouse with built-in capabilities for viewing and analysis, that lets hospitals create knowledge from all the existing data.

"Azyxxi allows a health system to tie together these separate elements into a single view—taking these IT systems, aggregating patient data [including computer generated, text, images, video, scan data, etc.] so that clinicians can get an instant picture of all the data in all the hospitals systems at any time," Shihadeh said. "It spans both user and business processes to provide customized data that spans clinical, financial and administrative systems, thus maximizing the value of information in order to make the most informed and timely decisions."

Meanwhile, higher health care spending does not guarantee better delivery or outcomes. Although the United States spends 16 percent of its GDP on health care—the highest in the world—it ranks only 37th in the overall performance of its health-care system by the World Health Organization. Moreover, more than 100,000 Americans die each year from preventable medical errors, IBM officials estimated in a report last year.

IBM also has offered its 180,000 U.S.-based employees a Web-based EHR (Electronic Health Records) system.

IBMs Grundy said the Congress relaxation of the Stark laws, which limit physician self-referral, will allow large hospitals with strong networks, such as the Mayo Clinic or Johns Hopkins, to create silos.

"You might see evolving silos around certain hospitals, with connectivity among their network of providers," Grundy said. "The question is, is there any motivation to connect beyond that" to other health care facilities?

"I hope a utility-based solution might make it easier for vendors to have their solutions connected and interoperable," Grundy said.

IBM is working with the University of Pittsburgh Medical Center to transform its IT infrastructure into a utility-based, on-demand environment while consolidating and virtualizing operations. As part of a $352 million IT solution, IBM will provide UPMC with hardware, software, services, and financing.

Are there other effective solutions?

Oates said, "There is a multitude of various projects taking doomed, proprietary approaches [e.g. RHIO initiatives, NHIN] that are getting a lot of press." RHIO is a Regional Health Information Organization and NHIN is a National Health Information Network, which would be made up of a network of RHIOs.

"There are a select few projects working toward an affinity driven approach that is likely to not only succeed, but completely disrupt a currently highly dysfunctional system," Oates added.

In his keynote, Wego said the more promising approaches to health information sharing are ADHINs—Affinity-Driven Health Information Networks. "I would describe their approach to be more national, affinity-based, open systems, standard Internet protocols/security, inclusive, and inexpensive," he said. "Affinity-based means they will bring together entities having a need to interact."

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