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Healthcare IT Leadership Requires a Thick Skin

 |  By smace@healthleadersmedia.com  
   September 25, 2012

Healthcare is in crisis, and I'm here to report that IT is no panacea.

In fact, if you're in a healthcare IT leadership position, doing your job may feel a bit like running the gauntlet. In this ancient, barbaric practice used by both Europeans and Native Americans, prisoners or wrongdoers were forced to run between rows of soldiers or warriors who administered beatings.

Contrast the bright, shiny promises of healthcare IT vendors with the brutal, unforgiving punishment of making wrong choices in IT program selection, training, budgeting, and deployment and you get the picture.

There's a reason they call it execution.

The right technology, deployed wrongly, can burden providers with crushing workloads, plummeting morale, and bad headlines.

It's tough to gain the confidence of payers and patients if laptops packed with hordes of personal information are being lost or stolen. When patient wait times go up and customer satisfaction goes down, the public isn't going to be satisfied by excuses blaming "technical difficulties."

And yet, technology may be the only thing that gets and keeps healthcare costs under control. In all my travels, I keep encountering dedicated healthcare executives who have spent their entire careers growing up with technology, making it do the seemingly impossible.

And then I hear about a hospital where claims data had to be transferred from provider to payer on reel-to-reel magnetic tapes.  And I walk away shaking my head.

But we are kidding ourselves if we think that the blazing fast computers of 2012 and the ubiquitous wired and wireless tendrils of the Internet are sufficient to complete the task at hand.

A mantra often repeated is that healthcare lags behind other industries in the use of technology. I would submit that the challenges healthcare faces are far greater than the challenges faced by other industries.

Lives are at stake. Just like healthcare itself, healthcare information needs to be delivered at the right time, to the right place, to the right people, and only to them. Yet we have a federal privacy law, HIPAA, which actually makes that more difficult than it should be. I wonder if it's even conceivable to modify HIPAA to bring it into the 21st century. Probably not while so many laptops keep getting lost and stolen.

I sympathize with CEOs such as Anna Roth of California's Contra Costa Health Services, who last week faced her second public worker protest since her system went live with Epic on July 1.

The first time around, it was the nurses, sounding alarms about patient safety and inadequate training. This time, Ori Tzvieli, MD, Contra Costa Regional Medical Center medical staff president, whose union is negotiating a new contract with the county, drafted a letter which was signed by 14 physician colleagues, including the chairs of the departments of family medicine, internal medicine, pediatrics, surgery, and dentistry. Talk about a gauntlet.

The letter brings fresh insight into the challenges this one system faces, challenges probably being faced by many other systems, only for whatever reason, it's all gone public in Contra Costa:

  • Since paper charts aren't available, clinicians are spending hours recreating "abstractions", summaries of medical histories, or are having to abstract them in real time during visits, further slowing care.
  • Unresolved processes not put in place at the time of go-live have to be integrated into the EMR.  
  • Huge amounts of work, such as nearly all discharge orders, have been shifted from medical assistants and nurses to providers.
  • While Epic recommended a particular reduction in expected patient load on providers during the transition, hospital leadership expects an accelerated return to normal workloads.
  • Some well-trained clinicians, known as super users, are having to return to normal duties, reducing their ability to help continue training others—a form of training particularly necessary with adoption of EMRs.

The list goes on and on.  Brenda Reilly, MD, chair of the department of emergency medicine, told county supervisors that one patient waited 40 hours to get a bed after the Epic go-live.

None of the new news stories included a comment from Roth, who I interviewed last month. I contacted her office again, requesting a new statement. Here is what she sent:

"We reduced workloads for medical staff when we went live with our electronic health records [system] to help support them during this transition. Based on staff feedback, patient rosters remain reduced, and we are committed to working collaboratively with staff to develop a longer term plan that allows us to continue to provide the highest quality care for those we serve. As with any electronic health record implementation, we knew it was only the beginning when we launched our EHR on July 1 and that this process would be ongoing. Our integrated health system presents both unique opportunities and hurdles.

Though the implementation process has been challenging, we have already seen benefits and are making progress. Many of the reported issues have been resolved and we are working aggressively on issues that remain. The EHR is one of many critical steps we are undertaking to ready our system for health reform, and we will continue to work side-by-side with frontline staff to meet these challenges and take these opportunities to transform and improve care."

It's probably only the public nature of such healthcare systems that exposes their woes to so much inspection. Systems with much more private governance may be in similar straits. But it can't be a good time to be a county hospital.

Not to dwell on Contra Costa's misfortunes, but if you think dealing with EMRs is scary, there are more dangers just around the corner.

The things I'm learning about ICD-10 downright scare me. This is a huge change to healthcare and the costs are considerable. In 2011, CMS urged providers to make sure they have a line of credit to cover interruptions or unforeseen changes in reimbursement due to the often unpredictable effects of the coding changeover.

I can understand why the AMA howls about ICD-10, including a comment from AMA president Jeremy Lazurus, MD.  But I also know the transition is key to HHS's plans to control costs and reduce fraud and abuse. More precise coding means the difference between a payer knowing that an amputated finger was barely nicked, to one where the injury was massive. Today's old-fashioned coding lumps it all together. That is unsustainable.

And yet, at Monday's HFMA Northern California chapter meeting in Santa Clara, I also learned that the very nature of ICD-10 makes the kind of analytics that healthcare so desperately needs harder to produce. Joseph Nichols, a Seattle-based consultant, just released a white paper about this that is required reading.

I'm not completely down on technology. Last week did see its fair share of technical progress. The iPhone 5 made its bow and Apple sold an astonishing 2 million of them in the first 24 hours. But as healthcare professionals, it is our duty to educate our patients, payers, shareholders, lawmakers and the public at large.

Bright shiny objects by themselves may offer instant gratification to the masses, but it does not necessarily follow that the technology transition now underway in healthcare is all that bright, or shiny. Sometimes it's like mountain climbing. Other times, it's more like that gauntlet.

One piece of advice: Think hard about whether this is really the time to build that bright, shiny new hospital structure you've been thinking about. You're going to need plenty of cash on hand to deal with the IT-related challenges I've just described.

I understand the temptation to build tangible things with healthcare dollars. As I left the HFMA meeting, across the street the new San Francisco 49ers stadium is rising from the earth. Healthcare wants its own tangible monuments. But it may have to postpone some of them for now.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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