A Vision of E-Health Nirvana - We Know What is Needed!

It seems that, given my advanced age and galloping decrepitude, that I will not last to ever see the E-Health nirvana. However, today, HIMSS Analytics has published the report that will allow me to slip off to the grave a “very happy Vegemite” knowing, at least, nirvana is possible!

Today, the following appeared in the overnight issue of the Health IT Strategist (HITS) – the Health IT publication from Modern Medicine in the US.

"Greater benefits seen in advanced apps: study

There are few substantial correlations between improved healthcare outcomes and "incomplete" electronic medical-records systems, according to a new white paper from the Healthcare Information and Management Systems Society and its not-for-profit subsidiary HIMSS Analytics, but the more sophisticated the EMR system, the more it improves the quality of care.

"Perhaps it’s appropriate to borrow a line from the addiction-recovery industry," the report stated. "When it comes to the electronic medical record, it appears that half measures avail us nothing."

On the other hand, along with improving quality of care, the white paper stated that advanced applications such as computerized practitioner-order entry and clinical documentation can also increase hospital revenues related to pay-for-performance initiatives.

The findings are based on a study of 107 University HealthSystem Consortium hospitals that looked at how well hospitals did on 63 quality measures developed by the Agency for Healthcare Research and Quality and how advanced the hospitals’ EMR systems were. The study split the EMR systems into eight different stages of implementation, but no hospital in the study had implemented a system in the highest stage, and less than 1% had implantations in the levels five or six. In fact, most hospitals were still in stages zero, one and two.

The report concluded that there was a significant increase in quality scores between the 39 level-three hospitals and the 22 level-four hospitals. A main difference between the two levels is that level-four hospitals have implemented CPOE. According to the report, stage-three hospitals had six slight positive correlations between their EMRs and AHRQ’s quality measures and only one strong positive. Level-four hospitals, however, had nine strong positive correlations and 11 slight positives. The strong correlations included the areas of acute stroke, heart failure in-hospital mortality percentages and gastrointestinal hemorrhage in-hospital mortality percentages.

-- by Andis Robeznieks / HITS staff writer"

The report, which makes very interesting reading, and draws, I must say, quite conservative conclusions, can be found at the following URL.

http://www.himss.org/content/files/UHCresearch.pdf

The core conclusion, re-stated is that to make a real difference with clinical systems what is needed is both Clinical Physician Order Entry and Clinical Decision Support based – not just on simple error checking but on ensuring that evidence based clinical protocols are being adhered to as frequently as possible. Obviously this makes perfect intuitive sense and supports the studies mentioned previously on the blog that show at the real benefits of clinical computerisation are really only to be had when advanced systems are deployed. (See the blog article Saturday, August 26, 2006 Interactive Electronic Decision Support Benefits - Keys to the Literature).

The findings of the report have a number of important implications.

1. There is more to assessing the value of a clinical EMR system than Return on Investment (ROI).

2. We are further assured that the major investments suggested by this blog are, in fact, necessary and that half measures are a waste of time and money. The UK has it right to at least attempt a quantum leap in the level of health system automation – the debate now is only really around are they going about it the right way!

3. The identification of the need for advanced systems to achieve real clinical outcome improvements makes a mockery of the penny pinching approach to Health IT being adopted by the present Australian Government.

4. The transformation task to get Australia from where we are now to where we need to be to really improve health outcomes and patient safety is a really, really big one that is not being helped by the lack of a National E-Health Strategy.

5. It is largely pointless attempting to develop benefits models and benefits realization approaches unless you make clear assumptions about the advanced nature of the systems required and ensure the business case recognises the scale of both the cost and the benefits.

6. It is no longer sensible to not have clear guidelines as to the capabilities and functionality that should be delivered to ambulatory (GP and Specialist) and hospital practice.

NEHTA needs to change focus and really start addressing these implications if it is not to become part of the problem rather than part of the solution.

David.