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By Erik Johnson
Senior Vice President
Avalere Health
Washington, DC
Mass Adoption
The government's incentive program for meaningful use of IT will lead healthcare organizations toward the widespread use of electronic health records (EHRs). At the same time, it could help the industry achieve many of the goals associated with health reform.
In the past, change movements have crawled slowly forward and gained little traction. By adopting information technology en masse, the healthcare industry will be in a position to bring about change.
In the early 1990s, the healthcare industry was attempting to reinvent itself under the auspices of managed care. The effort failed, in large part because healthcare organizations were rewarded for managing the utilization of healthcare, not for improving the quality of care. Moreover, most healthcare providers lacked the data and information necessary to manage clinical and financial risk successfully. So, providers simply managed the volume of services and care delivered, without effectively zeroing in on quality improvement.
Managing Care — Again
With health reform now a reality, providers once again will be asked to manage care. More specifically, patient-centered care, medical homes and accountable care organizations essentially offer up new business and care delivery models that require providers to manage both the clinical and financial risk of patient care.
EHRs should be designed to assist in such risk management. Although primarily used as transactional tools, the data that eventually will emanate from EHRs (and the sharing of the data via health information exchanges) could become very valuable as analytical platforms for payors, providers, and suppliers. As more providers adopt EHRs, the shared, aggregated data will help to identify trends and best practices that can ultimately lead to the more effective management of clinical and financial risk.
Meaningful Use Foundation
The challenge for the industry is to achieve widespread adoption of EHRs — and then to begin to share and learn from the data generated by the technology. The government's incentive programs for the meaningful use of EHRs, as dictated by the American Recovery and Reinvestment Act (ARRA), will help providers leverage EHRs for such quality purposes. The incentive program is likely to result in the widespread adoption of EHRs, helping healthcare organizations more effectively manage care — and, thereby, more effectively deal with some of the demands of reform.
To leverage the technology in this manner, though, providers need to concentrate on properly implementing EHRs. Racing to pull in incentive funds simply will not help achieve the many long-term benefits associated with EHRs. Thus, the call for meaningful use.
For example, a quick implementation by a hospital might hurt relationships with physicians — and limit a provider's ability to form strong partnerships moving forward. Indeed, history has shown that EHRs need to be implemented methodically and intelligently for providers to truly tap into the potential value of the technology. It is far more important to get the implementation right, than to get it done.
More Puzzle Pieces
Proper implementation of an EHR can go a long way in helping providers cope more effectively with the changes health reform is likely to entail, but leveraging EHRs to manage risk is just part of the overall equation. To cope successfully with reform, providers also need to:
 Build a parallel IT infrastructure that enables longitudinal data analysis. By turning the data
that emanates from EHRs into actionable intelligence, organizations will be able to identify
opportunities to realize widespread process and care improvement.
Develop relationships across the continuum of care. For example, hospitals need to form strong
bonds with physicians — and should start to reach out to post-acute care providers as well. As
such, provider networks will be much better positioned to manage a patient's entire lifecycle of
care, not merely treat patients in static bursts.
Propose innovative payment models to commercial payors. By coming together in a coalition
or through industry groups, providers could propose arrangements that help to align payors in
the pursuit of improved care.
With health reform's quality improvement and cost reduction mandates serving as motivation, leaders need to look beyond ARRA's meaningful use as a standalone goal and begin to realize that the proper utilization (or meaningful use) of electronic health records will help to provide a foundation for the complete transformation of the healthcare industry.
Erik Johnson is a Senior Vice President with Avalere Health, focusing on healthcare IT, hospital operations, and finance. Prior to joining Avalere, Johnson was Managing Director with Manatt Health Solutions, heading the Washington, DC office and focusing on the application of health IT to clinical challenges and opportunities, with a specific focus on clinical decision support and developing patient-centered medical home strategies for large integrated delivery networks.
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While half of hospital CIOs are worried about meeting 2011 meaningful use requirements, a full 80% are concerned about meeting the expanded 2015 criteria, according to a survey of 120 CIOs released by PricewaterhouseCoopers, LLC, a New York-based consulting firm.
The huge hurdle: As currently proposed, later stage criteria calls for healthcare providers to use advanced decision support, with 100% of order sets to be evidence-based. OhioHealth, a multi-hospital system based in Columbus, Ohio, is already on its journey to standardize evidence-based orders across its enterprise, supporting consistent, high-quality care.
After using paper-based order sets for years, the provider is now integrating evidence-based content into its computerized physician order entry (CPOE) system. OhioHealth is using third-party evidence-based content and review tools to streamline the build and maintenance of the enterprise-wide order set content. A key component to its success was establishing a cross-discipline governance committee to drive review and consensus of the content across its enterprise.
"Clinicians across our enterprise are contributing to the development of the evidence-based content," says Mrunal Shah, MD, vice president, Physician Technology Services, OhioHealth Information Services. "We send out the content to reviewers and get back reviews via an automated system. The automated review makes it easier for us to reach consensus on best practices. It also enables us to assimilate content across the enterprise instead of having separate content at each facility," Shah says.
"With our agreed-on content integrated into our CPOE solution, we are able to provide clinicians with evidence-based clinical data to guide the best treatment for our patients while allowing for necessary individualization of care." By leveraging the technology in this way, we believe we can continue to move toward meaningful use."
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