Washington Report- March 20, 2012

March 20, 2012 “More competition will drive down costs and exchanges will give individuals and small businesses the same purchasing power big businesses have today.”  Kathleen Sebelius, Secretary of the Department of Health and Human Services, commented after the release of the Health Insurance Exchange final rule on insurers competing for customers‟ business.  Ask the Expert: How can the latest data center technologies enable innovation across the healthcare delivery model?- By Steve Rich, Director, Advanced Solutions Group, Dell Healthcare & Life Sciences  Bridging the Great Divide to Achieve Meaningful Use Stage 2 – Part 1 of 3- By Angela Reed and Paul Rosenbluth  Unraveling the Myths about Evidence Based Medicine – by Andrew W. Litt, M.D., Chief Medical Officer, Dell Healthcare & Life Sciences  HealthWatch – A weekly digest of the latest news in the healthcare industry  #TopTweets – A few tweets worth noting this weekAsk the ExpertBy Steve Rich, Director, Advanced Solutions Group, Dell Healthcare & Life SciencesQuestion: How can the latest data center technologies enable innovation across thehealthcare delivery model?Though virtualization may not be recognized as “the latest” data center technology, I see itas the foundation for enabling innovation in the healthcare arena. We are seeing more andmore hospitals and hospital systems around the world taking advantage of the many benefitsvirtualization offers, including cost savings that allow them to drive innovation in other areas,eliminate the need for downtime during system upgrades and maintenance and improveaccess to data during disaster recovery.Virtualization essentially comes down to consolidating data centers. Moving servers to avirtual environment allows multiple operating systems to run on one server, which can helpcut down on real estate, power and cooling costs. For example, a hospital may have one datacenter that hosts 400 servers, each running only one operating system, and thus only use asmall fraction of their computing power. If the hospital moves their data to a virtualizedenvironment, so that each machine runs at 100 percent of its computing power, it can nowrun the 400 operating systems on as few as 60 or 70 servers. That hospital can now invest themoney they save by running 330 fewer servers on innovative technology that will improvepatient care.

Clinicians and application managers rarely experience downtime in system upgrades whendata is hosted in a virtualized environment. “Mission critical” data, or data that hospitalscannot afford to have down for routine maintenance and upgrades, is virtually hosted acrossmultiple servers, allowing more efficient data management and ensuring the data is backedup 24/7. Virtualization helps reduce downtime for scheduled maintenance by enablingflexibility and mobility. In a virtual world, a system that requires maintenance, whether it ishardware or software, can be moved to another physical box to complete the maintenance,while the mission critical data is still available to be used by the hospital.Hospitals must always be prepared for the unexpected disaster, when mission critical databecomes even more critical. During a disaster, multiple machines work together as a“cluster” to ensure that mission critical data is available for use. Mission critical data thatneeds to be hosted in a physical environment for maximum efficiency transfers automaticallyto a virtual environment, and though it may not run at its peak performance in the virtualenvironment, the data is accessible when it is needed the most.Moving data to a virtualized environment improves business continuity and data management,reduces costs and provides unlimited access to mission critical data. Virtualization is a key tounlocking innovation in the healthcare delivery model.Send your “Ask the Expert” question to Ask_Dell@Dell.com. Return to topBridging the Great Divide to Achieve Meaningful Use Stage 2 – Part 1 of 3By Angela Reed and Paul RosenbluthMeaningful Use has become the regulatory catalyst in healthcare to bridge the strategic gapbetween information technology (IT) tools and clinical quality outcome improvement efforts.Closing this gap is even more relevant now in order for caregivers to attain the proposedMeaningful Use stage 2 requirements.Long gone are the days of separating the IT functions from the clinical and quality realms ofbusiness. Stage 2 of Meaningful Use not only raises thresholds for specific Stage 1 objectives,but also introduces new objectives which clearly demonstrate the intent of meaningful use.That is why it is more important than ever for clinical, quality and technology initiatives to beseamless, coming together to create a holistic approach to putting the systems and processesin place to address the requirements for expanded interoperability, access to healthinformation by both patients and providers, and health information exchanges through truedata transport via a standardized transmission protocol.There is and will continue to be a significant and increased focus on leveraging technology topromote clinical decision support functionality and reporting on clinical quality measures,both of which contribute to an escalation in the requirement for structured data.

The Centers for Medicare and Medicaid Services (CMS) propose that to successfullydemonstrate meaningful use of certified Electronic Health Record (EHR) technology for Stage2, providers, which includes eligible professionals (EPs), eligible hospitals (EHs) and criticalaccess hospitals (CAHs), must attest, through a secure mechanism in a specified manner, tothe following during the EHR reporting period:  the provider used certified EHR technology and specified the technology was used  the provider satisfied each of the applicable objectives and associated measures  the provider successfully reported the clinical quality measures selected by CMSThe CMS-defined outcome priorities to which the specific performance objectives are eachindividually attached, including the following:  Improving quality, safety, efficiency, and reducing health disparities  Engage patients and families in their healthcare  Ensure adequate privacy and security protections for personal health information  Improve care coordination  Improve population and public healthIs your organization prepared to align IT and quality needs? Are your organization‟s qualitymeasures to meet these new Meaningful Use requirements integrated into your EHR and CPOEsystems? A strategic centralized plan with strong governance is going to be essential innavigating the newest course to Meaningful Use compliance. Return to topUnraveling the Myths about Evidence Based Medicineby Andrew W. Litt, M.D., Chief Medical Officer, Dell Healthcare & Life SciencesEvidence-based medicine (EBM) represents a significant shift in how American providersdeliver healthcare. While physicians have traditionally continued to increase their knowledgeof health and disease throughout their careers from scientific journals, continuing medicaleducation lectures, textbooks and individual experience, EBM elevates the focus onconsensus-based approaches and meta-data analyses.EBM empowers physicians with high-quality, relevant evidence that is coalesced intorecommendations, so they can make more informed, and hence appropriate patient decisions.It is also a key driver in the quest to reduce clinical practice variation, improve patient safetyand in general, enhance the quality of healthcare.Information technology and analytics are essential to the successful implementation of EBM.Without the rapid, real-time dissemination of knowledge, physicians will not have theappropriate evidence to consider. Many health systems and hospitals have already begun tointegrate advanced EBM tools and resources into electronic health record systems. In fact,The Institute of Medicines Roundtable on Value & Science-Driven Health Care has predicted

that "by the year 2020, 90 percent of clinical decisions will be supported by accurate, timely,and up-to-date clinical information, and will reflect the best available evidence."Separating Fact from FictionEvidence-based medicine has wide support across the healthcare community. However,because most physicians believe they already practice medicine based on the best availablescientific knowledge, without the technology and analytics, there remains a debate regardingthe role of this concept. Here are five of the most common fallacies vs. facts about EBM.#1 EBM is “cookbook medicine” that relies solely on evidence and disregards clinicalexpertise.In reality, it is only when evidence is combined with patient preferences and the physician‟sclinical expertise that it becomes a valuable tool. EBM does not suggest eliminating clinicaljudgment or the possibility of going outside of evidence-based protocols, if needed.#2 EBM is simply a tool to reduce costs.EBM does have the potential to reduce healthcare costs. A 2010 study found that evidence-based care for patients with non-small cell lung cancer (NSCLC) resulted in an average costsavings of 35 percent over 12 months, while demonstrating equivalent health outcomes.EBM can significantly improve patient care while reducing costs. By applying EBM, physicianscan avoid unnecessary interventions, such as the overuse of antibiotics and laboratory testingand/or imaging.#3 EBM is laborious and takes up too much of a clinician’s time.Because physicians are already over-scheduled, some may be concerned that EBM will requireextra time. EBM involves a multi-step process: first, the physician asks a clearly-definedclinical question, then finds and critically assesses the evidence. Next the physician mustintegrate the evidence with the patient preferences and clinical expertise to make a decision,and finally, evaluate the decision.A clearly-defined clinical question can narrow the scope of evidence needed, and informationtechnology can help speed the process of finding and analyzing the evidence. For example,electronic health records can provide real-time access to evidence, and advanced analyticsand tools built into the EMR should give physicians instant access to the critical informationthey need.#4 EBM reduces the autonomy of the doctor-patient relationship.Evidence alone, or the lack of it, does not dictate patient decisions. In fact, EBM seeks toconsider individual patient preferences and circumstances when weighing treatment options.By communicating the evidence to patients in a manner that values their autonomy,physicians can empower them to be more involved and informed in decisions regarding theirown care. In doing so, rather than posing a threat to the autonomy of the doctor-patientrelationship, EBM can help transform it into a partnership that can result in better patientcare.

#5 EBM cannot be practiced without randomized controlled trials (RCTs).EBM calls for factoring in the best available evidence when making patient decisions. In thehierarchy of evidence quality, systematic reviews of RCTs are at the highest level. However,an RCT may not always be available, or be the „best‟ in a particular situation. In cases wherean RCT is unavailable, EBM proposes the use of the next best available evidence category.One of the most significant challenges to EBM is that current studies don‟t do a good job ofclassifying all patients because each patient is unique. However, once large patient data setsare available and easily analyzed, it will be possible to tailor the evidence more closely to theindividual patient or small, similar group (e.g. African-American diabetics between 40 and 50years old with co-existing hypertension who are not obese).As we move toward a data-driven approach to improve clinical decision-making and patientoutcomes, it is important to acknowledge that EBM will not replace the wisdom of physicians.Instead, it will use sophisticated information technology and analytics to enhance clinicalexperience and play a key role in improving patient care. Return to topHealthWatchA weekly digest of the latest news in the healthcare industryHHS Releases Final Rule on HIXs- The Department of Health and Human Services (HHS)released its final rule for state-based Health Insurance Exchanges (HIXs) under the federalhealth reform law on Monday. Under the law, states must create HIXs that provide coverageoptions for individuals and small businesses by January 2014. States may either run their ownHIX, or ask the federal government to run it on their behalf. The 633-page final rule intendsto give states flexibility in developing their exchanges.Smartphone Disease Surveillance- The Kenya Ministry of Health and researchers from theKenyan Centers for Diseases Control and Prevention (CDC) conducted a study on gatheringdisease information with smartphones. They found that after the initial setup cost,administering questionnaires and collecting data on smartphones is actually cheaper thanpaper surveys. It costs about $61,830 to establish and run a paper-based system over twoyears, but only $45,546 for a two-year smartphone program. They found that fiver percent ofthe paper-based surveys were incomplete, whereas only three percent of the smartphonesurveys were incomplete. The study also revealed that seven of the paper-basedquestionnaires were had duplicated patient ID numbers, whereas there were no duplicateswhen using the smartphone.Tablets Improve Internal Medicine Resident Efficiency- A recent study published in theArchives of Internal Medicine found internal medicine residents were more efficient whengiven tablets to access medical journals, contact labs and other departments, view EHRs andshow patients their X-rays and test results. The results of the study showed that 90 percent ofthe residents routinely used the table for clinical duties. Seventy-eight percent felt more

efficient using a tablet, and 68 percent believed the tablet helped prevent delays in patientcare.The EHR Adoption Lag- A study published in Health Affairs found that hospitals that are noteligible for meaningful use incentive payments are less likely to adopt EHRs. The incentiveprogram excludes some providers, such as home health agencies, inpatient psychiatrichospitals, inpatient rehabilitation hospitals, long-term acute care hospitals and nursing homes.The study, which analyzed data from 2009, found that 12 percent of short-term acute carehospitals adopted at least a basic EHR system whereas only six percent of long-term acutecare hospitals, four percent of rehabilitation hospitals and two percent of psychiatrichospitals did the same. Without an incentive program, some of these organizations may notsee the benefit of adopting EHRs. Return to top#TopTweetsA few tweets worth noting this week @DellHealth Dell Healthcare Infographic: Austerity to Prosperity; the rise of digitization in the public sector: bit.ly/xmdWm2 #HC @ONC_HealthIT ONC Achieving #MeaningfulUse is important for improving care; learn how to reach this goal here: bit.ly/uk8Yzr @HITNewsTweet Healthcare IT News Webinar 03/16 (Friday): "Leveraging IT and Best Practices via Business Process Outsourcing" Register here: ow.ly/9yJk7 @AHLAlerts American Health Line Final rules say that HHS is developing a web portal to help states put together their #exchanges | #HCR @DellHealth Dell Healthcare Data #breaches dont have to be the "new normal" - Watch this 10 min #webinar to learn about the anatomy of #HC security threats.#HealthIT Return to topFor previous editions of The Washington Report, click here. To contact us, direct message uson Twitter @DellHealth or send an email to Ask_Dell@Dell.com.

Washington Report- March 20, 2012

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Washington Report- March 20, 2012 Document Transcript