Diagnosing the Problem – Healthcare, IT Experts Discuss How Their Worlds Are Colliding

When the federal government gave physicians a deadline to implement electronic medical records (EMR) in their practices, they were met with a flood of options, said Delcie Bean, president of Paragus Strategic IT, who saw a business opportunity to guide doctors through the process.

Unfortunately, “when medical records first came out, they were designed by technologists, not doctors. We saw that disconnect; they weren’t designed around how interactions are normally done,” Bean said at a recent seminar, “Technology Has the Power to Change Healthcare,” produced by BusinessWest and the Healthcare News, and sponsored by Comcast Business.

As a result, he continued, many practices tried out two or even three EMR systems before finding one they could work with, and that came with a cost. “We’ve seen improvements in that area, but there’s still a long way to go.”

The EMR landscape is just one facet of a larger problem, one discussed at length by Bean and two other panelists: Neil Kudler, vice president and chief medical information officer (CMIO) for Baystate Health; and Michael Feld, CEO of VertitechIT and acting chief technology officer of Baystate Health and Lancaster General Hospital.

That problem, in a nutshell, is that information technology in healthcare has not, to this point, been driven by the needs of care providers, and that has caused frustration and confusion and led to a situation where, Kudler argued, healthcare is at least two decades behind other industries in implementing new IT advances.

For instance, he said, compare IT in healthcare with the way the Internet has altered retail consumer habits. “None of you use a travel agency anymore, or go to one store, then another store, then another store,” he told about 100 people who attended the event. “When I grew up in the ’70s, it was a rite of passage to go to the mall. But my kids shop on Amazon quickly and easily, with the same momentary thrill as I had when I bought records in a record store.”

The difference, of course, is that IT advances in retail met well-established needs: greater convenience and the ability to quickly compare prices, which drives down costs. Bean said healthcare has been slow to identify exactly what it wants from technology.

“We’re all about grabbing market share, not creating better products,” he said, noting that poor EMR products left a bad taste in doctors’ mouths. “It’s leveling out now, though, and we’re starting to see need drive the innovation. We’re adopting technology because we want to do something better. As long as need drives the technology, we’ll wind up with products that are sustainable.”

Feld understands this, noting that his firm, VertitechIT, recently hired a doctor. “We’re pure IT,” he said. “We need to know more about medicine. IT often has blinders on; it doesn’t know what the customers require.”

As a result, he said, healthcare organizations — which have made striking advances in the use of technology to improve imaging, surgery, and overall quality of care — continue to struggle when it comes to implementing information technology.

However, that story might be changing.

Pushed Along

Specifically, Kudler said, if healthcare is moving forward, in some cases, it’s being moved by outside forces.

“The Affordable Care Act has really pushed us along, and has rocketed healthcare IT over the past five or six years because of federal mandates requiring us to make use of these technologies,” he noted. “Now, I hear from my friends and colleagues, ‘I didn’t go to medical school to be a data analyst, or to sit in front of a computer screen.’”

As the CMIO at Baystate, he continued, “my approach to healthcare IT is really, how do we make these technologies more seamless and integrated into workflow, so people are not held up by the computer itself, and so computers don’t take the place of a person? That really is the crux of technology: how can we engage the patients in their own care — and engage doctors, nurses, all the allied professionals — and make sure these technologies improve care without disrupting it in negative ways?”

Kudler said healthcare is at a sort of “nexus point” where providers must better understand technology if they don’t want to be frustrated by it, because changes are definitely coming — one of the reasons his role at Baystate is so critical.

“The CMIO is a position cropping up across the country and various health systems,” he explained. It is, in fact, an evolution from doctors who have long taken an interest in IT and promoted its adoption among their peers. It’s an important role, he added, because, in most cases, “there’s a very clear distinction between information technologists and those who deliver healthcare.

“Having not only the right resources and technology, but the right clinicians in place,” he added, “will drive demand for those technologies while building a powerful infrastructure.”

IT doesn’t come without concerns, however, among them the thorny issue of information sharing in an age of heightened privacy regulations.

“Privacy is a mandated issue; there are rules we all have to follow,” Feld said. “The real issue in sharing, from a technological point of view, is compatibility. That, frankly, is proving to be much more difficult.”

In short, he said, computer systems in various health systems were not built to be interconnected. “It’s parochial in nature. There’s no centralized location I can go to get data about a patient. These are problems that need to be overcome for proper sharing.”

And if patient data will eventually be connected, what about the challenge of ensuring that all providers have the necessary bandwidth access to reach it?

“There has been a lot of progress in that field in the last 10 years,” Feld noted. “The amount of infrastructure, fiber, and wireless towers installed in this country is amazing. Europe is still ahead of us in cellular technology and wired technology to houses, but that gap is narrowing quickly.

“We may have all this technology to collect data,” he added, “but unless this data is moved around to where it can be used, it doesn’t do much good.”

Even cities known for plentiful bandwidth, like Springfield, have gaps, Bean was quick to note.

“You can’t say, ‘Springfield is all set, Agawam is all set.’ Oftentimes, they’re not. If you open an office on the wrong street, you don’t have bandwidth. We have clients in Springfield who don’t have bandwidth, and they have to bear the construction costs of the carrier — $50,000, $80,000, $90,000. So many small practices can’t afford to bring bandwidth to their office.”

The panelists also touched on the issue of data breaches, like the recent one involving Anthem, which may have exposed 11 million customers’ medical and financial data to hackers. Feld said one challenge is convincing organizations that everyone must understand security matters, not just the C-suite and IT professionals.

“The real issue is that people aren’t aware of the security requirements in their daily operations,” he said. “It’s a dangerous thing to make two, three, or four people responsible for it. The community has to be responsible for it. At Baystate, we’re going to different groups; we are educating every one of the employees on proper security procedures — things as simple as password controls and not storing things on certain devices.

“It’s a major effort,” he added, but one that will bear fruit as more companies get serious about it. “You’ll see these kinds of breaks in the future, but you should see them start to decline. But it’ll take time.”

Bean agreed on the importance of educating entire organizations. “It could be reception, could be the HVAC installer, could be a more innocuous part of the organization that causes a breach in security,” he said. “You have to educate the end users, the vendors. You have to think about where the doors are being kept open right now.”

Tools of the Trade

None of the panelists doubted that healthcare has the ability to close the 20-year gap Kudler spoke of. But change might not be driven by large health systems alone, Bean noted.

“Because of the availability of technology and the fact that its cost is scaled to the size of the organization, we’re seeing some of the most advanced technology being used by the smallest groups,” he said. “Technology is an equalizer. Sometimes smaller companies are the most innovative, plowing a path for other organizations to see what works and what doesn’t work. Smaller clients are able to be more nimble than large organizations.”

In the end, though, “technology is not a silver bullet; technology is a tool,” Bean said. “You can’t advance technology without defining what outcomes you want to achieve — whether its more convenience or better care — and work backward from those. You can’t just say, ‘technology is a solution; let’s implement it, and good things will happen.’”

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