Proponents of local health information exchanges say they can provide more complete and timely information for treatment, as well as support quality improvement and reporting, public health activities, and clinical research. Findings from a study of stakeholder perspectives on participation in four HIEs by the Center for Studying Health System Change and the National Institute for Health Care Management Foundation suggest, however, that barriers to achieving data exchange remain high.
Remember the story of John Henry? He was a folk hero, in the same vein as Paul Bunyan and Pecos Bill, who was rumored to be strongest man alive in the 19th century and the greatest steel driver to ever hit a railroad spike. He led the westward expansion of the railroad by drilling straight through the heart of a mountain, a venture that cost the lives of a thousand workers, the story goes.
He was a hero and unmatched in his talent, until a salesman came along with a steam-powered drill that he claimed could out-drill any human. Threatened by the new technology and concerned about his job and the jobs of his men, John Henry challenged the inventor to a contest--man versus machine.
This tall tale immediately came to mind when I read a story this week about a computer that is more accurate at diagnosing certain brain diseases than human doctors. Experts programmed a personal computer to diagnose Alzheimer's based on brain scans and achieved a 96 percent success rate, considerably better than the 85 percent accuracy by clinicians using standard scans, blood tests, and interviews.
I've seen similar reports about the success rates of more encompassing diagnostic software that is already available on the market, in some cases for free. Once symptoms are identified, diagnosing is very mathematical; it's a matter of calculating the possible diseases that correlate to the specific combination of symptoms, so it makes sense that a computer would be better able to quickly navigate this matrix.
But only a very small percentage of physicians have embraced these diagnostic tools. In many cases this is because of budgetary or technological constraints, but some claim there may be a psychological component to physicians' resistance. Research suggests physicians tend to be overconfident in their diagnoses and receive inadequate feedback about their diagnostic mistakes. Combine that with the financial pressures to see more patients in less time, and it's a testament to physicians' extraordinary talents that they are as accurate as they are.
But here's the interesting part: The same technological advancements that many physicians currently reject could help them overcome those financial barriers. Not only diagnostic software, but EMR sharing, online prescriptions, and other high tech tools that physicians have been slow to adopt can improve efficiency, patient satisfaction, and the quality of care if used to enhance, rather than replace, physicians' skills.
And that's the key. Physicians should view technology like diagnostic software as another tool in their arsenal rather than as a threat or a nuisance. John Henry's tale ended with a victory, but he won the battle, not the war. After giving every last bit of strength in his body to beat the machine, he collapsed and died on the railroad track.
No machine will ever replicate the doctor-patient relationship or replace the judgment, quick-thinking, and empathy that characterize all good physicians. But physicians who have been reluctant to embrace new technology would be wise to examine the reasons behind their hesitance, and take a lesson from John Henry.
Customer service is more important for some practices--plastic surgery, for example--than others, but all physician practices neglect this crucial factor at their own risk. It is imperative that patients feel welcome in the practice, says Karen Husmann, MBA, practice administrator for The Aesthetic Center for Plastic Surgery in Houston.
She offers these tips for improving customer service:
Hire a good team. Forget motivating people. Hire motivated people and try not to de-motivate them, she says. The administrator cannot do it all. Hire the best nurses, the best receptionist, the best patient coordinator, and pay them well. Set up a bonus program that rewards all employees. Her practice's quarterly bonus program is based on profitability of the practice, base salary, and individual performance score on annual reviews.
Train staff members in "customer recovery." Empower them to "fix it" when a customer is unhappy. Give them the authority to waive a fee or offer free products, if possible.
Promote the right atmosphere. "When I interview individuals for employment, I tell them that, yes, we are a serious medical facility, but our mind-set is that of an exclusive, high-end boutique," Husmann says. "For those who cannot buy in to this, they are not hired." Also remember that it is the doctor who sets the tone, and the leaders/managers who mirror the behavior. If the leader is negative and pessimistic and views customers as problems, the staff members will follow suit.
Encourage a good interaction among staff members. Offer all-staff lunches when a customer compliments the staff and other fun events such as bowling night or movie night. Remember, Husmann says, customers will notice if you have a bunch of people in the office who like each other.
This story was adapted from one that first appeared in the February edition of Plastic Surgery Practice Advisor, a monthly newsletter by HealthLeaders Media.
Randy Cox, chief information officer at Riverview Hospital, Noblesville, IN, describes how he enlisted department leaders to define what they needed in an enterprise IT makeover.
Riverview Hospital faced a difficult decision. Its legacy hospital information system was being retired by its vendor, and the county facility wanted to forge ahead on the IT path. Based in Noblesville, IN, Riverview is a county-owned hospital that competes with several other well-established hospital systems in the area. The 170-bed hospital set out to deploy a package of up-to-date information systems that would automate its major functions, including imaging, revenue cycle, and clinical documentation. Rather than turning to one main vendor, Riverview adopted what its chief information officer Randy Cox describes as a "best of suite" approach.
The approach is a compromise between a single vendor solution, in which a hospital turns to a single primary vendor for its functions, and best of breed, which calls for multiple niche applications. With the best of suite philosophy, the hospital leans on one vendor to supply multiple modules for a core group of functions. For example, its revenue cycle management supplier, Keane, provides integrated software that handles registration, billing, and accounts receivables. Its clinical system, from Quadramed, handles results, orders, and electronic signatures for physicians.
During his presentation at HIMSS, Cox described how he turned the management of the complex project over to various department leaders. Before vendor selection began, department leaders created their own "success criteria" for what they wanted to achieve with the new technology. The effort included mapping common patient scenarios and the data exchanges needed to facilitate them. The effort laid the groundwork for the entire project, Cox said.
Now that the systems are in place, Riverview is seeing enhanced efficiency and wider use of the technology by physicians, Cox said. Half of its physicians use remote access technology to retrieve clinical information.
Cox's next step will be upgrading Riverview's 20 owned medical group practices--which encompass about 50 physicians--to a hybrid practice management and clinical documentation system from Misys. The vendor's open source software will facilitate broader data exchange across the community, Cox said.
Payments to doctors by medical device companies were the subject of a daylong hearing before the U.S. Senate Special Committee on Aging. Called "Surgeons for Sale?" the hearing was intended to bolster support for the Physician Payments Sunshine Act, which would require drug and medical device manufacturers to disclose how much money they give doctors through payments, gifts, honoraria, travel, funding for clinical trials and educational grants.
The Georgia Senate has approved a controversial plan to bring a $150 million cancer treatment center to Atlanta. The Illinois-based Cancer Treatment Centers of America has been lobbying hard to construct a cancer center in Georgia, but had been blocked by the state's "certificate of need" rule. The Atlanta Chamber of Commerce had opposed CTCA's expansion and pushed lawmakers to insulate Georgia's hospitals from competition.
Lawrenceville, GA-based Gwinnett Medical Center has received 1,000 letters of community support it sought in its quest to create an open-heart surgery center. Under state law, before GMC can build and staff a heart center it must obtain a certificate of need from the Department of Community Health. The community support helps demonstrate that need, say hospital officials.
Middletown, CT-based Middlesex Hospital's new $31 million emergency department will open the week of March 24, 2008. The new wing was designed to handle a patient caseload that has jumped nearly 50 percent in the last decade, and will be three times the size of the hospital's nearly 40-year-old emergency room.
HealthSpring Inc., a Nashville-based managed-care company, is claiming initial success with its pilot programs that pay doctors based on quality of care. Under HealthSpring pay-for-quality program that involves 27 medical practices, 348 doctors and 25,000 members, a practice can receive a bonus of up to 20 percent of what it normally gets paid.
