Health information technology: successes, challenges, next steps

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Massachusetts Governor Patrick's conference on health information technology, entitled "Improving Health Care and the Economy", began yesterday in Worcester, MA.  Dr. Blumenthal kicked off the conference citing achievements at the federal level and congratulating Massachusetts for being the first state to attain provider targets.

A down payment on health care reform

Quoting President Obama, Dr. Blumenthal told an audience of several hundred that health information technology, while important, is just the down payment on health care reform.  More important, he said are the aspirations of change we plan to achieve as a country.

HITECH anticipates and addresses barriers to reform

In his talk, Dr. Blumenthal noted that in addition to seeking change, the law also anticipates and addresses barriers to reform including financial and market barriers to technology adoption.   These hurdles  include the current absence of incentives to improve the quality of health care, the lack of incentives to adopt technology, and concerns about what technology to adopt and how to deal with productivity losses during the transition.

During the question and answer period, Dr. Blumenthal said that the standards that were developed in 2010 lay a strong foundation for the future.  Nevertheless, we will need to do more in the next round.  He also said that HITECH didn't cover the continuum of care because there was so much to address relative to acute care.

MA leads the way

Next up was Governor Patrick.  He announced that Massachusetts had succeeded in covering 98% of the population with just a 1% increase in state spending.  He then spoke about the importance of the health care sector to the Massachusetts economy, the prominence of Massachusetts organizations in various segments of the health care industry, and the extent to which Massachusetts institutions were leading the way in health information technology adoption.

He noted that cost remains a significant challenge-and one we must address to maintain universal coverage.  He advocated for doing so through better integration of programs and data.

Innovation Center will change the world

The next speaker, Dr. Sachin Jain, focused on the administration's commitment to health care innovation.  He said that the stimulus money leveled the HIT playing field, the Affordable Care Act improved access to care, and that the new Medicare and Medicaid Innovation Center will change the world.  Funded with $10 billion every ten years, it's goal is to identify new models for payment and care-and then diffuse them through the system.

The 7 doors of innovation

Dr. Jain then outlined the "7 doors of innovation."  These include RFPs, fast track pilots to modernize Medicare and remove policies that harm patients, requests for citizen input in problem identification and priority setting, sole source contracting, prizes and challenges, fast track for ideas that are already supported by evidence, rapid testing of new models of cares.

He said that one of the goals of the Innovation Center is to find models that work.  They will test various models since "one size will not fit all".

Dr. Jain invited the audience to submit their ideas.  In response to an audience question, he said that while priority may be given to coalitions that propose testing across multiple geographies, that doesn't preclude smaller tests for more targeted innovations.

Through the eyes of various stakeholders

The last session, yesterday, featured a panel that addressed the impact of health information on clinicians, patients, and the economy.  In his introductory remarks, Dr. John Halamka discussed some of the challenges associated with creating a health information exchange.  Examples ranged from the difficulties of uniquely identifying patients, to mismatches in vocabulary across the care continuum, to the problems with building quality measures by consensus.

Dr. Halamka also speculated that the deadlines for meaningful use will be extended to allow more time for vendors to develop software and providers to install and test it.  He predicted, that in the meantime, there would be an intermediary step where the government would require providers to achieve more aggressive goals for the technology executed in the first stage of meaningful use.

Physician perspective

Three of the four panelists were physicians.  Dr. Alice Coombs, representing physicians, discussed the steep costs associated with technology adoption in terms of finances, time, and reputation (until we get risk-adjustment right).

Vendor perspective

Dr. Bell, representing the vendors pointed out that the current EHR systems provide basic federal compliance saying that "everything else" is yet to come.  Her talk focused on some of the shortcomings of the current systems, the implications of these gaps, and the order in which vendors were addressing them.  Examples of shortcomings include the dearth of clinical decision support, the lack of assurances that multiple providers could simultaneously access systems, the absence of guarantees that functions would work together, data portability in the event of a bankrupt vendor, and the bias toward primary care physicians (rather than specialists or the rest of the clinical team).

Hospital perspective

Lynn Nicholas, representing hospitals, also talked about some of the cost considerations-both financial and in terms of eventual job loss.  She said Massachusetts hospitals face unique financial challenges because their facilities are older and therefore their net capital falls below the national average.

Consumer perspective

Dr. Charlotte Yeh, now Chief Medical Officer at AARP, said that her current role has given her a new appreciation of the consumer perspective.  She noted that professionals and patients have very different ideas of health care quality.  Whereas the professionals look at clinical measures, patients are more concerned with the quality of their lives.

Day 2: Workshops

Today, conference attendees, had the option of attending four workshops such as the ones I attended on Payment Reform, Secondary Uses of Data, and Telemedicine.  Each of these included a 15 minute talk by an expert followed by a half hour discussion.

Payment reform

Sarah Iselin of the Blue Cross and Blue Shield Foundation described some of the thinking behind Payment Reform, how it will differ  from capitation (e.g. providers don't take on actuarial risk, pay for adherence to quality measures, longer transition period), and the extent to which various factors drive cost.  Her talk was followed by a spirited discussion that examined payment reform from the perspective of each of the major stakeholders.

Secondary uses of data

Jo Porter, Deputy Director, NH Institute for Health Policy and Practice, provided examples of reports that New Hampshire, Vermont, and Maine have used their "all payer" databases to report.  The ensuing discussion included concerns about the privacy of patient data and a deeper dive into the relative strengths and weaknesses of data from various sources (all payer, discharge, government).


Joe Kvedar, MD, Director, Center for Connected Health at Partners Healthcare described how telemedicine could help bridge the gap between supply and demand for health care providers.   He then provided compelling examples of how telemedicine had improved health care access, quality, and efficiency for various conditions.  A lot of the discussion centered on barriers to use.  One of the topics was the difficulty of motivating patients to care for their own health.

All in all, it was an informative two day session.  One of the major conclusions that I drew after hearing all the speakers is that the devil will be in the details.

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