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While Wisconsin may be ahead of the curve in implementation of healthcare technologies, there's a long way to go before full use of electronic health records is common across the United States.
Despite the recognized quality improvements and long-term cost savings, implementation challenges can be daunting, notes Frances Dare, director of the Internet Business Solutions Group Healthcare Practice
of Cisco Systems.
Significant process change can be required. Implementation can be fairly expensive. And there are other significant barriers that need to be overcome, said Dare, a participant in the recent Digital Healthcare Conference presented by Wisconsin Technology Network. "It's not an undertaking for the faint of heart," Dare said in a post-conference interview, noting the many well-documented challenges involved in implementation.
Among those challenges are initial cost outlays, organizational cultures, process differences, regulatory issues, and interoperability of systems, not only within an organization but, also, between physician practices, insurers, regional healthcare initiatives and regional medical databases. More recently, Dare has seen a broadening of definitions in industry terminology present new hurdles. "In some cases, terms have become so broad that it's harder for people to communicate," she said.
The challenges are being addressed in myriad ways, including the federal government's effort to develop an Internet-based nationwide health information network. But that effort itself presents challenges, particularly among standards and governance, privacy issues, accurately matching patient identity, and cost.
A public-private collaboration, the American Health Information Community, will seek a market-oriented approach toward standards and interoperability.
The marketplace also will foster interoperability, believes James Prekop, president of TeraMedica
"There's too much public knowledge about healthcare costs out there now," said Prekop, citing information on costs of healthcare benefits pegged to each automobile manufactured by American automakers.
"When you get organizations placing blame for costs on health care, the incentives to get something done about those healthcare costs go up," Prekop said, saying digital records are one response to those cost increases.
Prekop supports the move toward national standards for records technologies, saying the standards will force vendors to measure their solutions against the standards.
But he doesn't see total interoperability coming any time soon.
"There's a goal, and then there's reality," he said. While incentives are being put in place to move toward interoperability, "it may not be something I'll see in my lifetime," he added.
The best immediate approach for a healthcare organization, Dare says, may be to start small, all the while recognizing that healthcare quality is the main goal.
"What we would suggest is to start with something simpler that would set the stage," Dare said, citing systems as simple as secure electronic messaging between patients and physicians.
"Our own experience is that it gives you some early wins, especially in hospitals where nurses and doctors may not be comfortable going online for such information."
The need to get those "early wins" that help build a culture open to technology adoption was universally seen by Digital Healthcare Conference participants as crucial to implementation success.
"When it's new, especially in that first week or two, there are challenges of acceptance," said John Melski, M.D., a dermatologist and medical director of clinical informatics at Marshfield Clinic
. "But if we've done our homework, and we bring respected physicians onboard early, the process goes more easily," said Melski, a conference participant.
Marshfield Clinic has a long history with healthcare technology, dating back to 1964 and relying on in-house development. Since 1994, it has had 100 percent adoption of EHR by physicians.
Froedtert and Community Health's Rodney Dykehouse stresses the importance of having the right people on teams that select technologies. "You team needs to include frontline people," said Dykehouse, vice president of information technology for Froedtert and Community Health. "And you need to identify people who will be barriers; bring them onboard and deal with their challenges."
Post-implementation listening is just as important as planning-session listening, Melski adds. "The technology people need to be committed to listening to complaints," he said. "I may not like the way a complaint is presented, but the complaint may still be legitimate."
Overall, the selection process needs to be solutions-oriented, not technology-oriented, Dykehouse added, calling technology for technology's sake
Leadership is another key factor in implementation, said Rick Gillis, M.D., director of clinical informatics at the Medical College of Wisconsin. "If leadership isn't fully behind it, it won't work," he told conference attendees.
Among the variables that can pose barriers on the road to EHR systems are regulations that not only are numerous but, also, can be open to interpretation regarding proper compliance.
"Regulatory requirements often pose barriers; that's just a reality we have to face," Melski said. "The proper interpretation of regulation is always a challenge."
The adoption of more technology in healthcare is inevitable, Melski says. "But I've felt that way for two decades - for most of my career. I long thought there was just no way an information-intensive profession could not pick up the tools eventually. The ability to remember or know all the facts, even on very primitive levels, can just be overwhelming."
He's now seeing the healthcare world move in that direction.
But paper will remain, especially among smaller and rural organizations, Cisco's Dare said.
"There are still many smaller organizations that are not doing anything" toward digital records implementation, Dare said. For them, the reasons to move toward EHR are less compelling. They not only need technology adoption incentives, they also need training and support services for implementation to work properly.
In other areas, Dare has seen smaller healthcare organizations purchase digital records solutions from larger healthcare organizations.
Such cooperation encourages TeraMedica's Prekop, whose company was a Digital Healthcare Conference sponsor.
"It was phenomenal to see organizations, that could be viewed as competitors, come together" on the issue of digital records, he said. "In the past, there was often no reason for those organizations to sit together. Now, it's become strategic to sit together."