Thursday, July 12, 2012

Here Is Another Reason To Really Wonder About The Durability and Sustainability of the NEHRS.


A couple of interesting articles appeared last week which deserve wider exposure.
First we had.

After SCOTUS decision, health IT orthodoxy worth rethinking

By John W. Loonsk, MD, CMO CGI Federal
Created 07/03/2012
Now that the Supreme Court has upheld the substance of the Affordable Care Act (ACA), a collective sigh can be heard, of relief by some and frustration by others, but certainly of avoided tumult.
The focus of ACA attention will turn to results or repeal. And while a different decision could have had ACA become a weight on HITECH and health information technology (HIT), the principally bi-partisan nature of the HIT agenda should now refocus attention almost exclusively on results for it.
It is from this latter perspective, though, that there may still be HIT tumult to come. HITECH was constructed from a health IT orthodoxy (set of tightly-held, common beliefs) that has shown a few cracks of late. And some of these cracks have to do directly with the population health IT needs of health reform from a program (HITECH) that is principally built around individual patient transaction technology.
Through the EHR looking glass
Specifically, cracks have developed in the view, which HITECH shares, of EHRs as the center of the HIT universe. EHRs, and not other aspects of HIT, are the overwhelming focus of the incentive funds. The Meaningful Use criteria, tied to those funds, look at almost everything through an EHR lens. Either as cause or effect, criteria and leverage are pinned to EHR certification.
Taking this EHR focus to an extreme, recent policy discussion has even gone so far as to suggest that almost all health data, including even patient experience data, must be made to flow through EHRs. It is almost as if all the other health IT systems in hospitals, much less other health related organizations, never existed and EHRs need to carry the entire burden of HIT expectations.
Interestingly, a recent commentary in the New England Journal of Medicine by Ken Mandl and Isaac Kohane, has strongly criticized EHR software for its complexity and lack of flexibility. The authors have been trying to develop app-like health IT capabilities for an ONC grant and no doubt are frustrated by current EHRs as a platform. They put the blame for these issues squarely on EHR software vendors. But while EHR software may be complex right now, even at the “app store” you get what you pay for, and the current orthodoxy has the country paying specifically for EHRs. It is not clear that EHR vendors should be blamed for creating them or creating them with increasing complexity to meet all of the MU expectations. This is exactly what their clients are asking for because of the incentive structure.
.....
A new orthodoxy
The collective breath holding for the Supreme Court ruling on ACA can now be exhaled. But it is an opportune time to examine the current HIT orthodoxy and see if it needs refinement moving forward. There are lessons from the immediately visible cracks that need to be considered.
First, we need to expect outcomes from health IT to be more long than short-term and we should anticipate that we will need to have a robust infrastructure to fully get there. Second, since many of the needs for, and benefits of, health IT seem to relate more to population than to individual patient care outcomes, the orthodoxy should prioritize population health IT to a greater extent than the focus on EHRs alone will allow. And third, the orthodoxy should focus more on good quality data and less on software. This focus may not be comfortable for those who fear talking about data aggregation and trusted data users, but it will be a more resilient direction that is less likely to get hung up in specific software issues.
It looks like the Affordable Care Act may here to stay for a while – and now we probably need to consider a HIT orthodoxy 2.0 to better support health reform goals.
Lots more here:
And second we had:

Patient Engagement Requires Right IT Tools

Federal and private policy makers are insisting that healthcare providers get patients more involved in their own care, but that's not going to happen without a careful analysis of your IT strategy.
Health IT managers could learn a lot from my car mechanic. Mike once explained the difference between "parts changers" and real mechanics--those who are skilled diagnosticians. Parts changers will look at your ailing engine, make a snap judgment about what's wrong, replace the part he suspects is at fault, and hope for the best. A good mechanic, on the other hand, works through a diagnostic process, looking for subtle clues, and bringing his in-depth understanding of the internal combustion engine to bear to find the root cause of your problem.
As most healthcare providers know, the federal government is insisting that hospitals and practices improve their e-patient engagement strategy in order to meet Stage 2 Meaningful Use criteria. Private insurers are already going down this same path. When faced with such mandates, health IT executives and clinical leaders can take the parts changer's approach to patient engagement, or do a deeper root-cause analysis to find the best technology to address the issue.
Before analyzing the issue, it makes sense to carefully define it. Patient Engagement Systems, a company that develops IT tools in this niche, says: "Patient engagement is a process in which patients become invested in their own care. Engagement develops naturally when there is regular, focused communication between patient and provider, and it leads to behaviors that meet or more closely approach treatment guidelines."
So how do you get patients more invested in their own care? Technology is only part of the answer. An organization's core mission and its attitude toward patients are even more important. I've heard many people complain about arrogant, distant physicians, nurses, and front desk assistants who give them the impression they are doing them a favor by granting them an appointment.
In this age of customer satisfaction surveys and online provider review sites, that philosophy is woefully out of date. The best healthcare organizations genuinely believe that it's their privilege to serve, not the patient's privilege to walk in the door. And no amount of technological wizardry is going to have much of an impact without this core value.
But even in customer-savvy hospitals and practices that really love their patients, tech tools are no magic bullet. Some providers are placing their bets on mobile apps or active video games--think Wii--to foster wellness and lifestyle changes, encouraging patients to participate in "exergames" to lose weight and improve their cardiovascular system, for example. In theory, that approach should work, but research suggests otherwise.
Full article found in the link in the text.
As I read both articles what is being said is that the Health IT paradigm is changing and being updated in all sorts of interesting and complex directions and that all the assumptions - even those that are only a few years old - are under challenge and re-consideration.
It seems to me the NEHRS program - with is conceptual base in the late 1990’s is under threat of just slipping into irrelevance as easier and better ways are developed to share and disseminate health information. I really have no idea where things are headed but I suspect things will be way more surprising than we can either believe or imagine.
I get the sense there are exciting times ahead - and I suspect the NEHRS will need to radically change and adapt or die.
David.

1 comment:

Cris Kerr said...

re A first look inside the PCEHR
Written by Kate McDonald on 12 July 2012.

http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=1078:a-first-look-inside-the-pcehr&catid=16:australian-ehealth&Itemid=327

' ... If you do want to restrict access to your record, or to specify that one healthcare organisation or provider can access it but another can't, you must create a Record Access Code (RAC). You then give this code to the organisation or professional to whom you do want to provide access. ... '

Question: If you create and share a Record Access Code (RAC) with an individual healthcare provider, does that facilitate 'individual healthcare provider' access or 'healthcare provider organisation' access?

This should be clarified because it is the difference between providing access to a single person OR all persons working at the same healthcare provider organisation.

Further, regardless of the answer, it would be difficult to place any trust in it because terminology, acronyms, and descriptors keep changing from one document and commentary to the next:

References:

(1) Draft Concept of Operations Aopril 2011, Section 5.5.2 - TERM: Provider Access Code (PAC) - page 55

(2) Concept of Operations, Sept 2011, Section 5.5.3 - TERM: Provider Access Consent Code (PACC) - page 69

(3) Article: 'A first look inside the PCEHR', Kate McDonald, Pulse IT Magazine, 12 July 2012 - TERM: Record Access Code (RAC)
http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=1078:a-first-look-inside-the-pcehr&catid=16:australian-ehealth&Itemid=327