A robot is helping doctors and nurses at Clearwater Valley Hospital in Idaho expand their access to big-city medicine. The 5-foot-2-inch robot connects primary care doctors with psychiatrists and other specialists at Saint Alphonsus Regional Medical Center in Boise. It also allows nurses, while they treat patients or assist in the operating room, to be critiqued and guided by experts at the larger hospital. Casey Meza, chief executive officer of Clearwater, said the robot is opening a new realm of medical services that wouldn't be available otherwise.
The conference center in Chicago is buzzing about the American Recovery and Reinvestment Act. Just about every hand shot up when Howard Burde, JD, a partner and health law practice group leader with the law firm, Blank Rome, LLP, asked attendees, "How many of you have a new favorite hobby: researching the ARRA?"
Providers are looking for answers to key questions:
What's in it for me?
What are the important dates and deadlines?
How do I secure the funds?
How will the feds define "meaningful use?"
During a session on strategies to manage the opportunities and risks for health IT in the economic stimulus, Burde said the ARRA, aka stimulus law, redefines government and private sector roles. "The federal government is taking over as the strategic leader," he said.
The main focus of the ARRA is to stimulate the economy, but it's also trying to reform healthcare at the same time, said Charles Christian, director of information systems and CIO at Good Samaritan Hospital in southwest Indiana. Healthcare IT can yield tremendous savings, but there are challenges to achieving those goals. For example, there is the manpower question. Do vendors and providers have enough staff members to implement all of this technology? The general consensus is no.
In addition, organizations have to revamp their processes if they are going to improve healthcare by the appropriate application of technology. "Just installing technology will not fix the problem," said Christian. "We are hoping this will give us the capital, but we are expected to do the work and show the outcome of that work before we get a nickel."
The law fundamentally redefines the language of heath IT—what is a qualified EHR and who will be the certifying agency. But one element the health IT section of the law doesn't include is accounting for disclosures, said Burde. That is in a different part of the law. "They didn't integrate a lot of the pieces together," he says. "Congress is counting on the regulatory process to fill it in."
So what will be the minimum necessary disclosure requirements? Will nurses and physicians have to enter a reason every time that want to access the EHR? Imagine the impact on workflow that would have in the provider setting. "Our job going forward will be to ensure that these disclosure requirements reflect reality," said Burde.
There are still a lot of questions about the stimulus package, but organizations shouldn't wait too long to start implementing their IT strategy, experts say. "It's not time to panic, but it is also not time to procrastinate," advised Christian.
The explosion of technologies that "connect" consumers online has shaped business models and created entirely new ways in which people network, socialize, and conduct business. E-mail, video conferencing, online retail, Google, LinkedIn, and YouTube have transformed our daily interactions with other people and the way we operate business. Ultimately, these same technologies will not only transform healthcare, but the way physicians and hospitals align to deliver care.
Consumers have demanded an enormous amount from the Internet in a short period of time. In the U.S. alone, online retail is estimated to have grown from virtually nothing a decade ago to over $130 billion a year. Consumers now routinely purchase products, pay bills, download statements, and make dinner or concert reservations online.
Although healthcare delivery has been slower to transform, many e-applications are in everyday. Among them are:
Live videoconferencing: Video and audio feeds over the Internet permit real-time communication among patients, attending providers, and consulting specialists. High resolution monitors, cameras, and broadband connections facilitate medical evaluations of patients by geographically dispersed practitioners, helping to alleviate access problems. Presently, this type of service is predominantly used by rural hospitals and clinics lacking specialty coverage. You can expect to see an increasing use of videoconferencing in clinic settings, nursing homes, emergency departments, and on acute-care patient floors, including intensive care units.
e-Interpretation services: Through the capture, storage, and forwarding of digital images and clinical data, local providers have access to specialty interpretations from remote specialists. This service is already common in specialties that rely on the review of images, such as radiology and dermatology. It is anticipated to expand to other services involving interpretations from images, including pathology, EKGs, echo-cardiograms, etc.
Patient direct e-Care: Originating from mail, telephonic, and e-mail-based technology, physicians offer consultative services directly to the patient. The services are provided through private organizations, hospitals, or through health plans with secured patient Web portals. Increasingly, the service will evolve to real-time clinical interactions using videoconferencing and electronic health records, especially as regulatory hurdles are reduced.
Remote patient monitoring: Home-based computers serve as devices to capture, trend, and transmit clinical data to healthcare professionals who monitor medical conditions of patients. Blood pressure, glucose levels, and weight changes are only a few measures that enable healthcare teams to respond quickly to clinical needs of the at-home patient. Expect to see usage of this technology expand in the home, but also in the hospital or skilled nursing settings. But what is the next phase? It is likely to focus more on the patient as consumer, with the aim of enabling hospitals and physicians to better communicate with their patients and deliver more efficient care.
Consumers will expect electronic delivery of healthcare advice and the ability to schedule services, access test results and reports, request refills, make inquiries, and dialogue with caregivers.
For certain conditions and patients, an entire episode of care may be electronic. It will include an e-inquiry into the primary care physician, followed by the medical issue identification question and answer process, to obtaining an e-consultation from a specialist, with relevant data transmitted back to the PCP and patient.
In addition to such transactions, online consumers will increasingly research the quality of providers. They will also want to socially network with their providers, either through medical blogs, online support groups, or social networking sites. Consumers will be comforted by watching YouTube-style videos of their providers performing the latest medical techniques and therapeutic applications. Healthcare providers without this virtual presence will suffer competitively.
As a result, applications such as community-oriented medical blogs, online support groups, video-based supplements, on-demand health advice, personal health records, and transactional applications will thrive. They will not only help to cement the bond between patient, physician, and hospital, but play an important role in broadening thinking regarding hospital and physician alignment strategies.
Moving forward, many alignment strategies will be a triad of hospital-physician-patient. They will be linked through systems designed to achieve clinically effective, efficient, informed, and safe care.
Recognizing this, Title XIII of the American Recovery and Reinvestment Act of 2009 (a part of the recently enacted stimulus bill) provides funding and incentives for the development, adoption, and upgrade of health information technology. The intent is to build a nationwide infrastructure that exchanges standardized health information, encourages the use of electronic health records, and trains clinicians on best practices.
As the options for "joint venture" types of hospital-physician alignment vehicles are defined through such legislation and regulation, taking ownership of the process to deploy these technologies presents an important opportunity to involve and align physicians and hospitals in a meaningful way.
The opportunity
The ability of the solo or small physician group to develop a comprehensive patient connectivity platform is relatively small. Therefore, it is incumbent for healthcare organizations to take proactive ownership of the process to build such platforms. In addition to serving as the foundation for a more highly integrated delivery system, the platform can reach out to patients and elevate their ties to both the healthcare organization and its individual clinicians.
Conceptually, the term "hospital-physician alignment" will give way to the term "hospital-physician-patient alignment," under which strategies and action plans are implemented to align the interest and needs of the hospital, physician, and the patient.
How these new affiliations mature will be just one component in a much larger strategy to reinvent healthcare delivery.
Steven A. Nahm is a vice president with the Camden Group, a hospital consulting firm in El Segundo, CA. He may be reached by e-mail at mailto:snahm@thecamdengroup.com.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
The government has set a goal for every American to have an electronic health record by 2014, and Kathleen Sebelius, the White House nominee for Health and Human Services secretary, calls the move to computerization "one of the linchpins" of overhauling the nation's healthcare system. But naysayers suggest health information technology is full of false promise. Digital records can lead to better care and fewer medical mistakes, they say, but the costly transformation could waste money if the doctors and hospitals buy systems that can't be connected to share information.
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