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Maximizing Quality from IT

HealthLeaders magazine, October 13, 2009
MORLEY: We're supporting the information technology needs of both hospitals' and physicians' EHR/EMR initiatives. Regardless of the setting, the collaboration between clinicians and the IT staff is critical. The sooner you start, the better off you'll be, because it often requires a minimum of 12 to 18 months to define the requirements, secure the necessary collaboration of all stakeholders, allocate the necessary budgeting, and develop an effective implementation plan with reasonable timelines. So my vote would be sooner is better.

VAUGHN: It's always hard with technology. It's a cold lake. You can dip your toe in but eventually you're going to have to jump in the water. There's a degree of brinksmanship here too. We've seen the stare-down between physicians and CMS annually. It just makes me wonder, if we're not getting implementation right, if they look at 2011 and they say, we've only achieved 5% or 10% or 20%, is there going to be a lot of pressure to back off? Because there will be a strong lobby saying look, it was unrealistic.

HEALTHLEADERS: Is the innovation pressure there to really make these IT tools be the effective clinical support tools that they need to be?

VAUGHN: It's a very good question because it comes as part of the overall EHR package. So have they applied as much attention as they should to these areas? Probably not. One of the steps that you were talking about is creating an integrated informational display of data for rounding. In the old days, you had to go look for nursing orders, you had to go look to the medication administration record, and you had to go look in lab. So we provide an integrated, one-page view that is incredibly popular. Now the problem is how to scale that down, because now we're looking at seven days of data on a 19-inch screen. It's like yesterday physicians were complaining that the screen wasn't big enough and there wasn't enough information on it. Now they want me to shrink it down to a little four-inch square for their handhelds.

MORLEY: From a vendor perspective, the primary challenge is one of the factors you mentioned—securing caregiver adoption. Generally speaking, the currently available technologies have the ability and flexibility to support these requirements. The more relevant question is whether we as an industry will be able to secure the necessary caregiver buy-in to effectively utilize available technologies.

HEALTHLEADERS: We see healthcare IT as it exists now, but we also have an opportunity now to deconstruct and rebuild. I'm curious, if outside of the constraints, what might some of those ideals be and are there ways to bring those into the discussion?

KICHAK: To me, it's always been evolution, not revolution. We have to see and use tools before we can change them. Once you get more people educated about what EHRs are and how they work, what data they contain, what they can and cannot do, then I think you'll get the ability to go around the country and have good discussions. Hopefully, the vendors could bring that knowledge base back together to take what physicians want to see and what they don't, and blend that with the next generation of ergonomic tools, with touch screens, with discrete data capture, so that you've got the best function, the best model, with the best technology.

PAUL: EHRs are maturing and the Web is evolving and maturing; to the extent that we can marry some of the functionality that we are getting used to on the Internet with the functionality that the EHR pioneers have been working on, that's where you finally get something that can aggregate the data in a way that works for your work flow, your priorities, and your patient population.

VAUGHN: Part of the problem is that healthcare is just such a moving target. EHR is going to have to follow and evolve with everything else in healthcare. A doctor coming out of medical school in the future should be able to understand statistics, should be able to use pretest probability, should be able to chew up any data that you throw at them and throw it back and say this is what it means and this is how I ought to use it to manage my patients.

MORLEY: The government has an opportunity to engage and invest in the healthcare community in a constructive way by helping to establish effective standards with reasonable timelines which will accelerate effective decision-making. We need to prioritize our goals, put the standardizations in place and aggressively move forward. The debates can go on forever, but I think that with effective government leadership, well-defined standards, extensive caregiver adoption, and a receptive technology community, together we'll be able to better assist the industry's transformation.
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