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Keynote speakers:
L - R. Susan Dentzer - moderator, Jacob Reider, MD - HHS, John Halamka, MD - Beth Israel, and Sachin Jain, MD - Merck.
Photo courtesy of Cambridge Healthtech Institute
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When President Obama mandated that the healthcare industry transition to electronic health records (EHR), the goal was to provide more efficient and better quality care. However, implementing an IT system and programs to achieve this was a significantly bigger undertaking than anyone anticipated, due to a number of obstacles. Highlights of keynote perspectives:
Jacob Reider, MD, Acting National Coordinator Health IT, from the US Dept. of Health and Human Services summed up a few key points:
1) Quality - Define quality? Everyone has a different definition. He believes we must change old definitions of quality into definitions of criteria that can be measured.
2) Usability - In order for the IT system to be used, it must be:
a) Pleasurable
b) Convenient
c) Usable
d) Reliable
e) Functional
3) Quality Chasm 2.0 - The standard electronic document has inputs for 814 pieces of information
a) Physicians remain in a document - centric, rather than electronic- centric mindset.
b) Physicians still enter notes into medical records, due to reimbursement rules.
4) Patient-centric - Patients must be the main focus and programs should be built around the patient
Summary: Reider believes that to provide better quality care and decrease cost, we need to "Shift left." Not until healthcare shifts from the hospital to the physician's office to the patient's home, will the quality of care go up and the cost of care go down.
John Halamka, MD, CIO of Beth Israel Deaconess Medical Center, discussed how at his institution, a social approach to improving patient care and decreasing cost has been taken. His thoughts:
1) Team group care - They share everything with the team and the patient
a) The data is translated into layman's terms
b) Patients are engaged in their care and they do things through telemedicine
2) Monitoring risky stats - A dashboard monitors how risky or safe the environment is and alerts the healthcare professional to outlier values.
a) Pilot Google glasses - The physician logs-in through QR codes as s/he moves from room to room, and patient to patient.
b) Physicians can access patient records instantly; this feature has prevented a patient from receiving a medication that would trigger an allergic reaction.
3) Analytics - The ability to extract relevant data from documents and generate useful data.
a) This applies to both internal and external generated data
4) Cloud - Health care professionals are reluctant to use cloud computing and storage, due to privacy and security issues.
a) The Center for Disease Control uses the same cloud as Amazon.
b) Benefit is that you have all the data from a single source.
Summary: Embrace the social approach. Dr. Halamka believes that with advances in technology, desktop computers will be eliminated and everyone will work from a tablet. The IT Department will be replaced by the Cloud Services Department. This paradigm shift will encourage more enablers and fewer providers.
O'Neil Britton, MD, Chief Health Information Officer, Partners Healthcare, talked about incorporating the patient as a partner in his/her healthcare and getting buy-in for better patient care.
He mentioned that the old way of delivering healthcare was built around the institution and that going forward, we must build care around the patient. Britton also noted that today, insurer payment is centered around delivering more care, rather than payment for better care and that practice needs to change.
By delivering care around the patient, we will shift away from immediate outcomes, to ongoing health care. To accomplish this, there will be 3 three types of Personal Health Records:
1) Patient controlled, 2) Patient portal and 3) Patient reported outcomes, where the physician and patient work together to determine those outcomes. Patients want connectivity through the use of mobile.
However, Britton sees a number of barriers to adoption:
1) Interoperability between computers and software
2) Patient computer proficiency and their health literacy
3) Cost
4) Perceived value
5) Privacy and security
6) Clinician's workflow - is it hindering or improving their workflow?
Summary: The concept of delivering better healthcare through the use of EHR is a paradigm shift in mindset and work process. There are many barriers to accomplishing this concept and it will take a while for the industry to figure out how to reach this goal.
The rest of the conference was divided up into four tracks:
1) Provider-Payer-Pharma Cross-Industry Data Collaboration
2) Coordinated Patient Care, Engagement and Empowerment
3) Population Health Management and Quality Improvement
4) Information Security and Privacy in Healthcare
While I was not able to attend all sessions, four main themes were universal across the presentations I attended:
1) Interoperability between machines - While institutions may be able to communicate within their own institutions or network, they are not able to communicate with outside networks. One of my speakers in track 2 talked about a Massachusetts initiative to build a Mass HIway, which would establish one central system for the state and all institutions would plug-in to exchange and assess information.
2) Patient centric - This industry realizes that in order to provide better care to the patient, patients must be the center of attention and must be fully involved in order for this concept to work.
3) Digital Era - We have moved from analog to digital and it is here to stay.
4) Paradigm shift - The market landscape is changing so the current system, or way of doing things is obsolete. We must find new ways to adapt to the new environment and new goals.
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