Digital Dilemma

The Hospitalist. 2009 September;2009(09):

September 1, 2009 | The Hospitalist

What’s Ahead

Technology integration is the next step. A handful of companies offer complete EHR platforms, including industry leaders Epic, Meditech, Cerner Corp., GE Healthcare, and McKesson Corp. Specialty firms, such as Johnson’s Salar, offer ancillary and support software and hardware.

Kendall Rogers, MD, assistant professor at the University of New Mexico School of Medicine and chair of SHM’s IT Task Force, says the stimulus funding dedicated to technology will be better served if it focuses on incentives beyond hospitals. Dr. Rogers and others want to see guidelines to create incentives for IT vendors to offer user-friendly systems designed to further medical efficiency goals.

“If this needed technology was developed and proven, the needs for carrots and sticks for adoption would be far less,” Dr. Rogers and several of his peers wrote in an unpublished letter to the NEJM. “Rather than focusing primarily on adoption of systems that have serious limitations … a bill that requires improvements in existing technologies would have much more impact in improving the quality of healthcare.”

Even before that happens, full-scale implementation of these systems will be a costly project that requires a long-term relationship with a vendor. Dr. Van Gomple’s hospital system, Sentara Healthcare, has budgeted $235 million over 10 years for its EHR implementation, according to Bert Reese, senior vice president and chief information officer. His accountants tell him to expect roughly $50 million to be subsidized by the stimulus package. The money is helpful, but not enough for a hospital or system that still needs to find another $185 million.

“The stimulus is nice to get things going,” Reese says. “But if you as an organization think that will cover the cost, you’ll never get going.”

Reese says Sentara’s return on investment at full implementation—roughly five years from now—will be about $35 million per year in savings. He suggests organizations view the investment through a long-term profit goal in order to show the value over an extended timeframe. Otherwise, some C-suites will be scared off by the initial outlay, failing to see the value of efficiency, cost savings, and improved patient care.

“It’s not an IT project,” Reese says. “It’s a clinical project.” TH

Richard Quinn is a freelance writer based in New Jersey.

References

Hamel MB, Drazen JM, Epstein AM. The growth of hospitalists and the changing face of primary care. N Engl J Med. 2009;360(11):1141-1143.
Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med. 2009;360(15):1477-1479.
Liebovitz, D. Health care information technology: a cloud around the silver lining? Arch Intern Med. 2009;169(10):924-926.

Image Source: ILLUSTRATION / ALICIA BUELOW

EHR Upgrade Faces Privacy, Communication Obstacles

Not surprisingly, money is often the hurdle mentioned first by hospitalists and hospital administrators when the topic turns to electronic health record (EHR) implementation. But as President Obama presses his vision of a more technologically efficient U.S. healthcare system, obstacles abound: security concerns, privacy guarantees spelled out in the Health Insurance Portability and Accountability Act, and interoperability issues when disparate systems from different vendors attempt to interact.

“Security and privacy are critical issues,” says Todd Johnson, president of Salar Inc. “[They] sit at the center of the debate on how you structure the entire national health record infrastructure.”

Johnson says vendors will ensure the integrity of information by falling in line with the Office of the National Coordinator of Health Information Technology (ONCHIT), which is tasked with creating standardized safety rules to allow broad, secure EHR access. David Blumenthal, MD, MPP, director of ONCHIT, says new rules extend privacy regulations to “health information vendors not previously covered by the law, including businesses such as Google and Microsoft, when they partner with healthcare providers to create personal health records for patients. It requires healthcare organizations to promptly notify patients when personal health data have been compromised, and it limits the commercial use of such information.”2

Most hospitalists and technology administrators agree that the interoperability problems—one hospital EHR system’s ability to communicate with all other EHR systems—could stymie EHR growth. Most industry leaders argue the hurdles are surmountable.

“We use the same security standards as banks, though it is a lot more profitable to steal money than to steal medical records,” says Ehab Hanna, MD, MBBch, FHM, assistant chief medical information officer at Eastern Maine Medical Center in Bangor. “[EHR] are more secure than the paper records, because there was never an effective way to prevent or monitor any unauthorized access or copying of the paper record. We can do that in the electronic world.”—RQ