Patients Define Evolving Expectations for HIT

If providers keep up with the tools available to patients, and turn yesterday's one-page brochure on a disease into tomorrow's Web site or mobile app, they will continue to be at the center of patient care.

What's the value of health information technology?

That's the question being asked during this week, National Health IT Week, organized by the Healthcare Information and Management Systems Society (HIMSS).

Certainly health IT has been very good to the members of HIMSS. The billions in Medicare incentive money paid out to providers in the past several years have enriched participating health IT vendors in a way that few portions of the IT industry have been able to enjoy, even considering the dot-com boom and the Y2K scare.

In Verona, WI this week, attendees of Epic's annual user conference are marveling at the company's brand new conference center, which holds 13,000 people. That's one big corporate conference center.

Out here on the West Coast, unionized nurses at Sutter Health targeted Epic in a press release titled "Sutter's $1 billion boondoggle," which described a scheduled eight-hour EHR outage followed by an unscheduled Monday morning outage that the nurses claimed exposed patients to risk.

Officials at Sutter sent me this statement:

"Sutter Health undertook a long-planned, routine upgrade of its electronic health record over the weekend. There's a certain amount of scheduled downtime associated with these upgrades, and the process was successfully completed.

"On Monday morning, we experienced an issue with the software that manages user access to the EHR. This caused intermittent access challenges in some locations. Our team applied a software patch last night to resolve the issue and restore access.

"Our caregivers and office staff have established and comprehensive processes that they follow when the EHR is offline. They followed these procedures. Patient records were always secure and intact.

"We appreciate the hard work of our caregivers and support staff to follow our routine back-up processes, and we regret any inconvenience this may have caused patients."

I tried to find out more details about the risks to which nurses said patients had been exposed, but a spokesman for the California Nurses Association has yet to provide me with details. One press report stated that patients were not getting their medicine throughout the day, and that the glitch originated not with Epic's software but with virtualization software from Citrix, software which increasingly controls how desktop and tablet users access applications.

Meanwhile, on the complete opposite end of the health IT spectrum, physicians and patients are fascinated with the latest innovation to hit the operating room, Google Glass.

Let's hope those glasses aren't rose-colored. Somewhere between the devilish details playing out at Sutter and the innovations of Google and others, all while U.S. healthcare is going through an unprecedented transformation from volume to value, is the reality of health IT's value.

It's not a panacea, but without health IT, we probably wouldn't even dream of healthcare's creative destruction or innovative ways of engaging patients.

Geeta Nayyar MD is a practicing rheumatologist at Florida International University in Miami, Florida whose other job is CMIO of PatientPoint, one of the largest providers of TV-based education in practice waiting rooms and exam rooms – and more broadly, any technology required to engage patients in managing their own care.

"You want to make sure the content that people are reading is accurate, which is a large part of what we're doing at PatientPoint," Nayyar says.

But how much difference can this make in an age when the vast majority of the population conducts Google or a smartphone's app store for medical advice before they ever contact a doctor or nurse?

"It's a great question," Nayyar says. "Part of being an empowered patient is knowing where to look. When I am thinking of starting [patients] on a new regimen, I tell them, please do go out there and find information, but I want you to find the information from these trusted sources that I think are good – the Arthritis Foundation, the American College of Rheumatology, the Lupus Foundation. Absolutely go online, talk to your friends, but these are the top five sources that I trust as your physician."

To me that defines not only the value of health IT, but also the value of the healthcare provider in this Google age – as curator, guide, Sherpa, coach and counselor.

Not quite the authority figure of old, but if providers keep up with the tools available to patients, and turn yesterday's one-page brochure on a disease into tomorrow's Web site or Pinterest page or mobile app, they will continue to be at the center of patient care.

As Nayyar notes, "anybody who reads the side effects on something like Tylenol would be terrified of taking it." It's still the clinician's role to put the plethora of information out there in context.

I am struck by the number of practices, however, that have a long way to go beyond just installing an EHR. Scheduling technology, or the lack thereof, continues to be a barrier to coordinated care. Recently I heard someone remark how much better an experience it would be if an elderly patient with five chronic diseases could go to a single exam room, then have visits with all her specialists in that same room, rather than have to get from office to office – an exhausting experience for many elderly patients.

Even better, how about being able to have multiple specialists at the same appointment, as appropriate?

To me, it is those kinds of patient expectations that are defining the new value of health IT.

That requires some scheduling technology. Sounds simple, until you realize that EHRs may or may not be able to help, that each practice may have its own silo of scheduling software, that each provider carries a mobile device – probably his or her own – that may or may not be in sync with the office's schedule, and the patient has his or her own schedule that ought to be able to coordinate with the providers' schedules.

But too often, we spend too much time and too many steps trying to sort all this out. The value of health IT is multiplied when it adheres to standards in everything from medical records to scheduling.

Savvy providers will always find ways to innovate on top of basic services and standards, to stomp out waste and inefficiency and delight employees and patients. True, the landscape has changed forever, and there will come a day when most patients will hardly ever visit a doctor in person. But we're in the business of health, not healthcare.

"We all wish we had five hours with each patient, but it's not realistic," Nayyar says. "The average office visit is like 8 to 10 minutes and typically docs are dealing with several disease states, but that's why I think health technology is so great, because you're able to extend that conversation beyond the office walls."

So, Happy National Health IT Week. We may not be a nation of e-patients yet, but somewhere between the Google search and the office encounter, we're learning.