20 May Health IT Stimulus Act: The future of healthcare IT will not come easy
Editor’s Note: Dr. Charles Kennedy spoke at WTN Media’s Digital Healthcare Conference on the topic of “Health IT Stimulus Act: A unique opportunity to improve healthcare delivery and integration”. Click here to view his presentation.
As a member of the Health Information Technology (HIT) policy committee, Charles Kennedy is in an influential position to help shape the future course of an American health care system that is out of control and seriously in need of a fix.
Kennedy, who serves as vice president of Health Information Technology for WellPoint Inc., the country’s largest health plan, was one of 20 people named to the committee that will advise the National Coordinator for Health Information Technology on implementation of a national health information network. The HITECH Act signed into law by President Obama as part of the stimulus package provides almost $20 billion in incentives and other funding for broad deployment of health information technology.
Kennedy spoke recently at the Digital Health Care 2009 conference in Madison, providing his perspective as both a medical doctor and one who is well versed in health information systems. In an interview following the conference, Kennedy talked about some of the challenges before the HIT committee as it works to develop a strategy to meet the goals of the HITECH Act.
Too much information
When Kennedy was in medical school, he recalls that physicians told him they knew everything there was to know about the practice of medicine, including all the various ways to treat patients. Contrast that with the state of modern medicine today, where specialists in an area such as gastroenterology can no longer keep up with all of the research and various advances in the field.
“The amount of information that is available for doctors to take care of patients has just exploded, so, it is impossible when they are trying to keep that stuff in mind to take care of the patient,” Kennedy said. “So, we need information management for doctors.”
A second major factor is that chronic disease is making health care costs spiral out of control, as it is responsible for 70 to 80 cents on the dollar for what is spent on health care, Kennedy said.
“You don’t go to one doctor and get fixed, you have several people, and each one has to know what the other is doing,” Kennedy said. “You have teams of doctors, so they need a way to communicate with one another so they can do the right thing. You need that way of sharing information so that the patient gets the best care.”
The response to the increasing complexity has been to make medical records on paper digital, so that medical professionals can retrieve the information easily, and use that data to help make more informed decisions in the care of the patient.
What is commonly in practice today are capture and display systems that merely display medical records, he said. Most of the systems draw a trend line, but it is mostly capture and display so that a doctor or someone else can use it.
Spending and quality not linked
A study that ranked spending on a state-to-state basis noted that as costs increased, there was less use of evidence-based medicine. The reason that costs went up in states was the increased use of specialists, which didn’t square with the quality ranking, Kennedy said. With increased use of physicians, there was less sharing of data.
“There is this problem of exchanging information,” Kennedy said. “Ideally, what we want to have happen is that all the doctors know what they are doing, and act together in a coordinated team effort to give the best care. What we know is that most of these entities are not sharing data in any kind of meaningful way.”
The fundamental problem is one of delivery complexity, as most of these entities are not sharing data, and have no computer infrastructure to manage the process, Kennedy says.
“Is it any wonder that you see the mess?” he said “And, you have a six- to tenfold variation in cost that we see in our data, routinely,” he said. “So it becomes a matter of how we create the sharing of information across those doctors.”
Ontology addresses issue of complexity
“People say we have electronic banking, so why don’t we have electronic health care?” Kennedy said.
The reason is the nature of health care data is such that each different piece of data means different things depending on the patient, and that introduces a level of complexity that is hard to deal with – it’s conditional information.
Only recently has a technology emerged to deal with the problem of conditional information. Developing an ontology allows conditional knowledge to be applied to a patient inside a computer via a data architecting system that arranges the data in a certain way. It can be accessed through a variety of browser-based tools via the Internet.
Creating an ontology is an effective way of dealing with the complexity of medicine by applying a set of rules to determine what is the best approach or procedure that can be done in the treatment of the patient, Kennedy says. The ontology can be shared with the doctor and the patient in the care process so that is it is current.
“We now have a way of understanding who you are, your disease, and what should happen to you (medically),” he said.
In a pilot program with Kettering Hospital in Dayton, Ohio, WellPoint integrated its claim data with Kettering’s clinical data to create an Integrated Health Record (IHR). The goal was to involve the doctor and the patient in a common set of data that they both use for improvements in both quality and efficiency.
“What we are starting to do is create health plan business rules and summarize the data to create a coherent record,” Kennedy said. “When we have a record that is the same record that the doctor is using to manage your health, when you have asthma, you can go home and see what you are supposed to do.”
Through the Kettering IHR, WellPoint saw improvements of 10 percent to 40 percent with patients who were in compliance with preventive health interventions in association with their illness. And, 45 percent of those with the highest illness burden accessed the system at least six times.
“The people who had the higher illness burden had a lower trend, so it would appear to have some value. Our experience is that it does save money, and it does improve quality,” Kennedy said, adding that WellPoint approved the requested medical procedure 90 percent of the time in the Kettering Hospital pilot.
“This could be what Congress has in mind,” he said. “If you can involve the patient and the doctor around a common set of data that they both use, that has the evidence base applied to it, you very well might see some improvements in quality.”
The problem is that many of the health IT tools don’t have the kind of proven track record that creates value, Kennedy said.
“You can get a health IT system and turn off a lot of important pieces of functionality, so it doesn’t create the value,” Kennedy said. “And there is this whole notion of meaningful use – what are the criteria? So that is another piece of it. Congress wants those systems to have clinical decision support. Let’s say I have a formulary on a piece of paper. If I have it on an electronic screen, is that clinical decision support?”
As part of the HITECH Act, Congress wants the HIT Committee to create standards and requirements that are strong enough so that health information systems are deployed that will make the quality of care better, and at a lower cost.
“The existing health care system is so wasteful and so inefficient and not at the level of quality and safety, that if we can deploy the right health IT, we can remove the kind of financial burden that our country faces,” Kennedy said. “I see it as something as very important to get done and get done right.
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