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- 1. Recognizing Value In and Realizing Value From Health InformationTechnology Authors: Joan McQueen, Angela Robinson, Rebekah Ruyts, Pam Shirley and Tak Tang
- 2. Topics Covered RecognizingValue In Health Information Technology (HIT) History Benefits and Risks Electronic Health Records Personal Health Records E-Prescribing Health Information Exchange Telemedicine Wireless Technology
- 3. Topics Covered (cont’d)Realizing Value From Health Information Technology (HIT) Benefits Measurement Program ROI (Return on Investment) vs. Value New Capabilities in Health Information Technology (HIT) Electronic Health Records (EHRs) Computer/robotic solutions Public service aspects of Health Information Exchanges (HIEs)
- 4. Recent history ofHIT: The Institute of Medicine’s (2001) call for the use of electronic prescribing systems in all healthcare organizations by 2010 heightened the urgency to accelerate United States hospitals’ adoption of Computerized Physician Order Entry (CPOE) systems. In 2004, President Bush signed an Executive Order titled the President’s Health Information Technology Plan, establishing a ten-year plan as this technology is essential to put the needs and the values of the patients first and gives patients information they need to make clinical and economic decisions. Recognizing Value in HIT
- 5. With healthcare costsand quality assurance taking priority in patient care, increased attention has been focused towards the potential of HIT to lower health care expenses, improve efficiency, quality, and safety of healthcare delivery. Some of those improvements include: Electronic Health Records Personal Health Records E-Prescribing Health Information Exchange Recognizing Value in HIT
- 6. According to theHealth and Human Services Recovery Program: “ Recovery funding has been designated to modernize the health care system by promoting and expanding the adoption of health information technology by 2014. Achieving this goal will reduce health costs for the federal government by over $12 billion over the next 10 years.” - From HHS.GOV Recognizing Value in HIT
- 7. General benefits ofHIT Elimination of chart-pulling, chart-filing, chart loss. Easy electronic review of patient information before visits. Notification of completed diagnostics and labs to review. Notification of required follow-ups, tests, etc. Improved timeliness of care team communications. Recognizing Value in HIT
- 8. General benefits ofHIT (cont’d) Potential reduction in medical errors with decision support systems and easier access to relevant information Reduction in prescription errors and subsequent time lost communicating with pharmacies. Reduction of adverse drug reaction/ interactions via immediate access to drug-drug and drug-food interaction alerts. Recognizing Value in HIT
- 9. General benefits ofHIT (cont’d) Easy communication with patients’ other providers, specialists, hospital visits, etc. More complete and detailed information available for claims, malpractice suits, etc. Potential reduced costs for labor and supplies related to charts and chart maintenance. Improved flow of information between staff members. Recognizing Value in HIT
- 10. General risks ofHIT Workflow disruption. Decreased productivity. Costly set-up and costly maintenance. Lack of adequate funding can jeopardize completion of projects. Low technological competence among staff — problems with adjustment, fear of change. Recognizing Value in HIT
- 11. General risks ofHIT (cont’d) Perceived unhappiness among patient population — “you talk to the computer, not me.” Technical limits in your practice (no high-speed connection, etc.). Chosen Health IT product doesn't adequately fit needs (e.g., have to double-document or sustain paper-based processes and electronic processes). Recognizing Value in HIT
- 12. Electronic Health RecordsRecognizing Value in HIT “ The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting.” --HIMSS, 2009
- 13. Personal Health RecordsRecognizing Value in HIT “ The PHR is a tool that you can use to collect, track and share past and current information about your health or the health of someone in your care. Sometimes this information can save you the money and inconvenience of repeating routine medical tests. Even when routine procedures do need to be repeated, your PHR can give medical care providers more insight into your personal health story.” -myPHR.com
- 14. Personal Health Records(cont’d) Recognizing Value in HIT Important points to remember about a Personal Health Record: PHRs are owned and updated by the healthcare consumer, not the provider. The information can be electronically shared with care providers as the consumer has determined it’s usefulness to their care. You should always have access to your complete health information.
- 15. Personal Health Records(cont’d) Important points to remember about a Personal Health Record: Information in your PHR should be accurate, reliable, and complete. You should have control over how your health information is accessed, used, and disclosed. A PHR may be separate from and does not normally replace the legal medical record of any provider. Recognizing Value in HIT
- 16. E-Prescribing More thanan electronic medium, e-Prescribing improves the management of patient drug histories and provides immediate access to decision-support information at the point of care delivery. It accomplishes this by: Eliminates handwriting issues. Creates electronic records to ensure prescription information is not lost. Recognizing Value in HIT
- 17. E-Prescribing (cont’d) Improvesdata exchange between prescribers and pharmacists. Expedites prescription refill requests and medication delivery. Reduces costs by improving work efficiency and identifying less expensive drug options. Recognizing Value in HIT
- 18. E-Prescribing (cont’d) Checksfor allergies, drug-drug interactions, dosing errors, therapeutic duplication, pregnancy-related issues and other patient-specific factors. Maintains an accurate, comprehensive drug database. Provides up-to-date formulary and insurance information. Recognizing Value in HIT
- 19. Health Information Exchange(HIE) The terms “RHIO” and “Health Information Exchange” or “HIE” are often used interchangeably. RHIO (regional health information organization) are a group of organizations with a business stake in improving the quality, safety and efficiency of healthcare delivery. Recognizing Value in HIT
- 20. Health Information Exchange(HIE) (cont’d) The goal of HIE is to: Facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care. HIEs also provide the infrastructure for secondary use of clinical data for purposes such as public health, clinical, biomedical, and consumer health informatics research, as well as institution and provider quality assessment and improvement. Recognizing Value in HIT
- 21. Recognizing Value inHIT Telemedicine A general term used to describe the ability of telecommunication and technology to be used for consulting or remote patient care. Telemedicine is being used in a variety of medical related areas such as radiology, cardiology, surgery, home health and oncology.
- 22. Recognizing Value inHIT Telemedicine (cont’d) Uses for Telemedicine: video-conferencing dispensing medications blood pressure checks glucose monitoring ECG on demand wound care updated treatment plans allows physicians to consult on various procedures from different countries
- 23. Recognizing Value inHIT Wireless Technology: Benefits Advances in wireless technology have become important tools in HIT Wireless technology allows for formerly stationary IT systems to become mobile via cellular and WiFi connections Allows improved accessibility to areas of hospitals previously not accessible (e.g. OR)
- 24. Recognizing Value inHIT Wireless Technology: Benefits (cont’d) Allows real time communications which can lead to improvement in care team interactions Can increase patient safety and improve patient care through workflow improvements
- 25. Recognizing Value inHIT Wireless Technology: Limitations Reliability variances Accessibility variances Lack of standards for coverage and speed in areas of hospitals Cost/budgetary constraints/lack of funding sources
- 26. Recognizing Value inHIT Implementation of Wireless Technology Requires: Thorough site surveys to ensure in areas of installation that wireless signals will be accessible and reliable in the targeted area of use. Site survey should be done before a design plan is developed and implemented.
- 27. Recognizing Value inHIT Implementation of Wireless Technology (cont’d) Requires: Evaluation of organizational needs to ensure proper wireless infrastructure will meet established needs-current and future. A well planned wireless infrastructure can accept new technologies with only minimal changes to the current design.
- 28. Realizing Value fromHIT Benefits Measurement Program Realizing value from HIT is not always easy, either in measurement or assessment. Traditionally, the Return on Investment (ROI) model has been the standard for determining whether a new process, piece of equipment or technology is value-added to an organization. Realizing value has, for the most part, been seen in terms of bottom-line cost reductions.
- 29. Realizing Value fromHIT Benefits Measurement Program (cont’d) However, measuring the value from HIT is not that cut and dry. Other models for realizing value need to be employed in organizations who have or will adopt HIT applications.
- 30. Realizing Value fromHIT Benefits Measurement Program (cont’d) One approach to realizing value from HIT is by implementing a benefits measurement program. In their article “Measuring IT Benefits: Let Us Count the Ways", David Greenwalt and Steven Riney suggest that there are four steps to this approach.
- 31. Realizing Value fromHIT Benefits Measurement Program (cont’d) Identifying benefits and metrics prior to project funding or approval Determining baseline measurements Performing a benefits opportunity analysis Performing a post-implementation benefits audit
- 32. Realizing Value fromHIT Benefits Measurement Program (cont’d) First, the key benefits the organization expects to achieve from implementing the new solution and which metrics will best determine whether the project has met its goals should be identified. The benefits should be those that most closely represent the organizations strategic direction. Ideally, there should not be more than 12 identified benefits for which effectiveness is measured.
- 33. Realizing Value fromHIT Benefits Measurement Program (cont’d) Once the benefits and metrics have been identified, a baseline for each metric needs to be calculated. Clarifying the definitions and calculations of each metric while determining the baseline will be useful in mitigating discussions post implementation during the benefits realization phase.
- 34. Realizing Value fromHIT Benefits Measurement Program (cont’d) In performing a Benefits Opportunity Analysis, one should look to established best practices, however, in reality, there are few standards for best practices. To determine the opportunity for achieving any individual benefit, and organization should do four things.
- 35. Realizing Value fromHIT Benefits Measurement Program (cont’d) Identify any national standards or benchmarks. Review any published studies by similar organizations. Evaluate the methods used to obtain these results. Balance these factors with the organization's own culture and capability.
- 36. Realizing Value fromHIT Benefits Measurement Program (cont’d) Finally, a post implementation benefits audit needs to be conducted. This is probably the most critical step in assessing IT implementations, as the real value in building a plan is measuring against it and learning from the differences.
- 37. Realizing Value fromHIT Benefits Measurement Program (cont’d) These authors also propose that the three main reasons IT-related investments fail to deliver value are as follows: Poor alignment of processes and technology Inadequate process change A lack of executive ownership and accountability
- 38. Realizing Value fromHIT ROI (Return on Investment) vs. Value Focus on “Value” instead of ROI. True “Value” can be recognized by an organization if a change to an integrated leadership model is made. Integrated leadership involves collaboration among IT professionals, clinical professionals and financial officers.
- 39. Realizing Value fromHIT ROI (Return on Investment) vs. Value (cont’d) Involves a common goal and a willingness of all parties to listen to each others’ perspectives. Power struggles need to be left at the door and joint decisions need to be made for the good of the organization. Needs to be a proactive process instead of a reactive process.
- 40. New Capabilities inHealth Information Technology (HIT) Electronic Health Records Advances in EHR applications extend the depth and breadth of record keeping by having the ability to store: Email Voicemail Scanned Images Recorded interviews, which is especially helpful in mental health Patient photos (before and after)
- 41. New Capabilities inHealth Information Technology (HIT) Telemedicine Advances in telemedicine applications extend the physician’s capabilities through computer/robotic solutions. This is particularly exciting for parts of the country that can’t attract or retain highly trained specialists due to lack of population and/or advanced facilities.
- 42. New Capabilities inHealth Information Technology (HIT) Health Information Exchanges (HIEs) Development and expansion of HIEs will do much to serve the public good in the following ways: Tracking drug seeking activity Identifying and tracking child abuse Identifying infections by monitoring patient data
- 43. Conclusion As canbe seen from the previous slides, there are a variety of ways to recognize value in and realize value from health information technology. Advances in these fields will also offer new opportunities for advancing patient care. This field will continue to grow and advance, especially with incentives such as those included in the ARRA of 2009.
- 44. Conclusion (cont’d) Otherbusinesses and industries are far ahead of the healthcare industry in terms of IT adoption, and there is a need to bring healthcare into the 21 st century. If one looks at healthcare in its most fundamental form, it is an “information” business, so recognizing the value in and realizing the value from HIT is critical as we move forward with healthcare reform in the United States and globally.
- 45. REFERENCES Agency forHealthcare Research and Quality (2006). Costs and Benefits of Health Information Technology. Retrieved on November 10, 2009. Link available at http://www.ahrq.gov/downloads/pub/evidence/pdf/hitsyscosts/hitsys.pdf . AMA (2009). Risks and Benefits of Health Information Technology (Health IT). Retrieved on November 10, 2009. Link available at http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/health-information-technology/putting-hit-practice/selecting-hit/risks-benefits-hit.shtml . Ankerstjerne, W. D., & Rehman, M. (2009). Wireless technologies. In Health Informatics Series: Anesthesia Informatics, Springer: NY, pp. 425-436 Arlotto, P., et al. (2007). Chapter 2-Healthcare information technology as a strategic asset: A framework for value management. In Arlotto, P., Birch, P. C., Crockett, M. H., Irby, S. P., (2007). Beyond return on investment: Expanding the value of healthcare information technology. Chicago, IL: Healthcare Information and Management Systems Society, pp. 7-14. Greenwalt, D., Riney S. (2007). Measuring IT benefits: let us count the ways. Healthcare Financial Management, 61(2), pp. 86-92. Healthcare Information and Management Systems Society (2009). Electronic Health Record. Retrieved on November 10, 2009. Link available at http://www.himss.org/ASP/topics_ehr.asp . Healthcare Information and Management Systems Society (2009). HIMSS Health Information Exchange (HIE). Retrieved on November 10, 2009. Link available at http://www.himss.org/asp/topics_rhio.asp . Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., and Taylor, R. (2005). Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs, 24(5), pp. 1103-1117. myPHR (2009). What is a PHR? Retrieved on November 10, 2009. Link available at http://www.myphr.com/index.php/start_a_phr/what_is_a_phr/ .
- 46. REFERENCES NationalePrescribing Patient Safety Initiative (2009). FREE electronic prescribing… for every physician in America. Retrieved on November 10, 2009. Link available at http://www.nationalerx.com/ . Telemedicine.com: http://www.telemedicine.com/whatis.html U.S. Department of Health and Human Services (2004). HHS Fact Sheet--HIT Report At-A-Glance. Retrieved on November 10, 2009. Link available at http://www.hhs.gov/news/press/2004pres/20040721.html . U.S. Department of Health and Human Services (2009). Recovery Programs: Health Information Technology (HIT). Retrieved on November 10, 2009. Link available at http://www.hhs.gov/recovery/programs/index.html#Health .
Editor's Notes
- #2 This presentation is meant to cover two key areas of health information technology. The first key area covers the ways in which value can be recognized in HIT. If HIT is to achieve its potential and be implemented effectively in health care, there needs to be a recognition of the value it brings to health care and health systems. The second key area covers how value can be realized from HIT. The traditional value assessments using return on investment models do not take in to consideration many of the intangible benefits that can be realized through HIT in health care. Therefore it is necessary to look at other models for assessing value and presenting the assessed value in a way that can be appreciated by CFOs and CEOs so that adequate funding will be allocated for implementation of HIT solutions. The end of the presentation includes a brief look at some of the exciting new technologies that are on the horizon in HIT. 1
- #3 Slides 2 and 3 are simply a listing of the topics that will be covered in the remainder of the presentation. No additional explanation is needed here. 2
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- #5 The IOMs call for the use of e-prescribing systems in all healthcare organizations is based on the following statistics: medical errors are the fifth to eighth leading cause of death in the United States, which exceeds the motor vehicle accident death rate of 43,500 per year each year an estimated 7,000 people dies from medication errors, with prescribing errors being the most frequent source it is estimated that adverse drug events injure or kill more than 770,000 people in hospitals annually (worldwide), most being preventable medical errors published studies report that CPOE reduces medication errors up to 81% The President’s Health Information Technology Plan states that by computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care. The plan addresses longstanding problems of preventable errors, uneven quality, and rising costs in the Nation’s health care system. By ensuring that most Americans have an electronic health record, patients will be more informed, not only about their own health care, but about the costs associated with that care. All of this needs to be done, however, in consultation with dedicated health professionals. 3
- #6 Health care costs continue to spiral out of control, and HIT holds the promise to reduce costs by streamlining processes and establishing best practices for standardization of care. Patient safety and quality of care are of major concern and the focus of health care practices, which is needed in order to improve on the statistics presented in slide 4. The following slides will touch briefly on the improvements listed in this slide. 4
- #7 According to Hillestad et al, $12 billion may be a very conservative estimate of reduction in health costs. They speculate that at 90% adoption for both inpatient and outpatient care, the savings could average more than $77 billion per year after complete implementation. They propose the largest savings will come from reduced hospital lengths-of-stay, nurses’ administrative time, drug usage in hospitals, and drug and radiology usage in the outpatient setting. They estimate that Medicare would see about $23 billion of savings per year and private payers would realize about $31 billion in savings per year. These numbers are significant in addressing the health care cost crisis in the United States. 5
- #8 This slide is predominantly self-explanatory. I think the main points are that there can be a reduction in administrative costs with bullet point 1. The second bullet point addresses streamlining of processes by allowing the physician or care provider to get a complete picture of the patient without having to wait for a chart to be pulled or having to dig through a lot of paperwork. This would also apply to bullet point 3. The fourth bullet point has to do with quality of care in that an automatic reminder of needed routine tests will help physicians provide the best care by not letting these items slip through the cracks. One example is that of reminding the physician that a patient is due for a mammogram. If that reminder caught breast cancer early in only one patient, it would be worth it. The last bullet point again has to do with quality of care, as more efficient communications can be very beneficial when time is an issue in getting the patient the correct care. 6
- #9 For bullet point 1, decision support systems with accurate and up-to-date information can help the physician choose the best practice mode of treatment and reduce errors by using treatment plans that are in line with current standards. Bullet point 2 was covered fairly well in an earlier slide, but it should be added that many physicians have cited that the time spent communicating with pharmacies is a strain on their ability to spend time with patients and conduct other value-added tasks. Bullet point 3 has also been covered, except for the additional benefit of HIT that can help to identify drug-food interactions. These adverse interactions have not been covered extensively in the available research but are probably more significant than is commonly realized, so patient safety is covered in this bullet point in more than one way. 6
- #10 Bullet point 1 assumes that there is interconnectivity between providers and facilities. Bullet point 2 talks to cost recovery by being able to code claims based on actual procedures and the potential to have more detailed information available to help reduce malpractice settlements. Bullet point 3 again addresses a reduction in administrative costs associated with chart up-keep, maintenance and storage for archival purposes. Bullet point 4 allows for different staff to have more information available in a timely manner. 6
- #11 Bullet point 1 mainly applies to the implementation phase of technology. This risk is considered to be temporary while staff are learning to use a new technology solution and perhaps new work processes associated with the technology. There is also a human comfort level that needs to be overcome before this risk is overcome. Bullet point 2 is seen as a major barrier to HIT adoption. The upfront costs can be staggering, and maintenance costs are ongoing. Often the ones who realize the most value from adoption are not the ones who are being asked to implement the technology. This is a gap in adoption of HIT. Often projects are not completed on time, are over budget and don’t really provide the solution that is needed, so funding runs out before the project can be completed and the value realized, which is what bullet point 3 is trying to convey. Perhaps the biggest, but often overlooked, risk is that of trying to accommodate the fear of change by the providers and staff. The human change management element is critical, and may be the hardest to overcome. 7
- #12 There has been some concern on the part of patients that they are losing the human connection with their provider by having the provider typing notes into a laptop and ignoring the patient. Patient’s still want the human connection and the use of technology makes many uncomfortable. Bullet point 2 has to do with the potential technical limitations in physician practices. This is not as much of a concern in larger facilities, but it is a risk in smaller offices and rural/remote locations. It is often difficult for physicians to sift through the mountains of data and large number of technology solutions that are available to determine which will best fit their needs. This leads to the wrong solution being chosen, which ends up in duplication of effort and disappointment with HIT overall. 7
- #13 The main points to emphasize from this slide are as follows: The EHR is a longitudinal solution. It is intended to follow the patient through every encounter with any care delivery setting. The ultimate goal is to have a lifetime patient record for each person. The EHR includes many elements, including patient demographics, progress notes, problems, medications, vital signs, past medical history, lab data and radiology reports, to name a few. The EHR is intended to streamline the clinician’s workflow by automating several aspects of the clinician’s work. Along with supporting patient care, the EHR will contribute to the use of evidence-based decision support systems, contribute to assessing quality management through measurements and data, and assist in outcomes reporting that will be used in continuous improvement programs. 8
- #14 Personal Health Records are being promoted more and more as people are being encouraged to be participants in their own health care and maintenance. Mainstream companies like Google and Microsoft are creating and promoting PHR applications, and many other custom PHRs are available through other companies. The PHR can be a powerful tool as long as providers have the ability to exchange information with the PHR of the patient. This is still a fairly new concept, so it’s long term use and acceptance have yet to be determined. The next two slides point out the critical differences between the PHR and EHR, which need to be emphasized to avoid confusion as to the purpose of each. 10
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- #17 The patient safety and quality of care as related to prescription errors was discussed in a previous slide. This slide and slides 17 and 18 are fairly self-explanatory in terms of defining the key points of value derived from this technology. 12
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- #20 In general, health information exchanges are designed to offer interconnectivity and interoperability between providers, either at a regional level (RHIOs) or on a broader scale, such as the proposed development of a National Health Information Network (NHIN), where providers across regions and states are interconnected. The key benefits are outlined on slide 20. 13
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- #22 Telemedicine is a critical piece of technology that is being used currently and whose use will expand in the coming years. Telemedicine encompasses several disciplines, and some of the key areas of value are in shorter patient stays in hospitals, reduced number of doctor outpatient visits, increased quality of care through real-time patient assessments from remote locations and the ability to call on experts for consultations from around the world. The current uses for telemedicine are outlined in the next slide (slide 22). 14
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- #24 Wireless technology has become an integral part of our everyday lives, so extension into the health care field is a natural fit. One of the most popular adaptations of wireless healthcare technology thus far is the enablement of accessing and updating electronic medical records (EMRs) at the point of care. This allows for positive patient ID checks and matching of patient wristbands with medication packages, charts and records. It also allows the clinician to view, review and update all patient information in real time at the point of care. Wireless technology also allows users to continually upgrade as technology becomes proven without the disadvantage of discovering a new technology’s shortcomings due to premature deployment. This slide and slide 24 highlight some of the key benefits of wireless technology, along with what was mentioned in these notes. 15
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- #26 Limitations still exist for wireless technology. There still needs to be greater reliability in up-time, with application performance being available 24/7 with no interruptions to service. Not all areas of the country have access to wireless networks, and no standards currently exist for hospital settings. The cost of these technologies can also be limiting, as implementation and maintenance cost can be extremely high. 16
- #27 Implementation of wireless technology in a hospital setting must be carefully thought out and planned. The obstacles can be almost endless, and are largely specific to a facility, so require design on a case-by-case basis. Some of the interferences can be caused by imaging equipment, monitoring equipment and lead lined walls. Maximum performance must be planned for in order to provide the maximum return on investment. This slide and slide 27 highlight some of the key factors in wireless technology implementation. 17
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- #29 This slide through slide 37 talk about a benefits measurement program that could be employed by an organization to assess the value realized from HIT implementation. The traditional ROI model is not adequate to take into consideration the value realized by the intangible benefits of HIT, such as patient satisfaction, work process improvements and patient involvement in their own care. HIT must be viewed as a strategic investment, not as an expense to be managed. 18
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- #39 Not only is the traditional ROI model no longer applicable to assess the value realized from HIT, but the leadership model of organizations also needs to change. As this slide and slide 39 point out, there needs to be true collaboration and accountability for value assessment, implementation and realization. This is another way that value can be assessed, along with the benefits measurement program, and perhaps goes hand in hand with the benefits measurement program. It can be seen from these preceding slides that there needs to be a paradigm shift in the way healthcare organizations operate and make HIT decisions. 22
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