27 May The healthcare IT executive perspective
Editor’s Note: The healthcare IT executive panel took place at WTN Media’s Digital Healthcare Conference on the topic of “View From The Top — The Executive Perspective”. Click here to view this presentation.
At the Digital Healthcare Conference 2009 in Madison, several healthcare executives from University of Wisconsin Hospitals & Clinics along with venture capital investor John Byrnes of Mason Wells answered questions and discussed the role that technology will play in improving the quality of health care delivery. Panelists included John Byrnes, Executive Managing Director, Mason Wells, oel Buchanan, Medical Director IT Services, UW Hospitals & Clinics and Mark Kirschbuam, SVP Quality and Information, UW Hospitals & Clinics. Moderator and conference chair Peter Strombom posed questions to the panel.
Moderator: Do you believe that we will have one system with many faces, or many systems with a common protocol?
Kirschbaum: The UW Hospitals are on the third year a four-year implementation of electronic medical records using the Epic system. We are humbled by the challenge of integrating many disparate systems within our four walls. We brought in our interface guru to show the group the monster that we have in terms of the interface of all of our systems. Based on our experience, the beauty of an integrated solution is very appealing, but, in all likelihood, its hard from me to fathom having anything other than a system of many faces that is coordinated with many different standards. Given where we are, internally, the challenge of doing it even within the walls where one would assume we have more control within a single entity – the prospects of trying to get anything integrated with different business drivers and single entities seems to be overwhelming.
Buchanan: If we are looking from a patient’s perspective, and thinking that a hospital in Madison and a hospital in Monroe should be able to communicate their records – what is the problem? I am pessimistic that we are going to solve that issue anytime soon. The development is bottom up – each enterprise system develops it and then sends out tentacles to other organizations to communicate. The Veterans Administration is the exception, they have developed a system so that all the information looks the same whether you are in Detroit or San Diego, and I don’t see that happening with the rest of our health care enterprise.
Moderator: How do we prevent repetition of what we have today?
Kirschbaum: There really has to be some business drivers and mandates that will pressure us to think other than parochially. I think there are drivers that will come into play that will force us, such as will we share in episodes of care, including how we are paid.
Moderator: From a governance point of view, how should we approach it? Should there be any changes in the form?
Byrnes: The clinical domain is where most of the action is right now. There is a need to get the information to the point of care in a timely fashion. I think that is the primary concern. Second, is trying to reduce the cost associated with it. I think the private sector vendors are the ones who are coming up with the solutions. The battle will continue for the next decade until they slowly migrate toward a way of sharing their information between IDNs. What we are hearing now, in the conversations at the boardroom, most integrated delivery units want to use their information systems to competitive advantage, so they are not interested in sharing it with other institutions. They think their ability to gather information, analyze it and deliver it is going to draw patients into their system, so they are feeling proprietary about it.
Audience question: With respect to rural health care, the thing that we are seeing out there is vendors with their proprietary applications kind of hogtying in regard to a facility that may look at an application, they want to tie into the clinical EMR, or whatever, and they are not able to afford the interface costs. Either vendors have to start realizing that the interfaces that they are doing over and over to tie facilities together – they’ve got to get their costs down, or the facilities have to come up with more money to pay for that. We are facing that over and over again. It’s a big issue, and it’s a huge issue for these hospital administrators. They can’t afford it, they are not quite ready to merge with a larger entity like Aurora or Mayo Clinic.
Kirschbaum: I think of the small hospitals as being in the middle. Many of the smaller physician clinical practices are affiliating with larger hospitals that already have an IT project, so they can piggyback onto that, but the smaller hospitals don’t want to give up control. A vendor tends to recommend against a lot interfaces from existing systems, because it’s easier to make systems from one vendor work together.
Byrnes: The information that is relevant to doctors and the nurses, that information is going to stay within the IDNs – it’s going to be a long time before that is readily shared. I think the people feel who manage that information feel that it’s a competitive advantage. I think the government is going to mandate and consumers will demand that they will have more access to the more superficial personal data that comes out of that process.
Moderator: Do I hear you suggesting that clinical information is being used for competitive advantage?
Byrnes: I think people see that as something is coming, I think software vendors are selling it to the IDNs, as such: “If you buy our system, you are going to manage patients more efficiently, have better outcomes for patients. Therefore you are going to attract more patients.” As this openness in medical information initiative that is taking place across the whole country, where consumers of medical care are going to be given greater access to the efficacy of care within a particular IDN so they can find out how good this provider is – it’s going to happen. There is going to be some portability, and there’s a competitive advantage to being good at doing heart transplants, for example, and I think that’s going to be embedded into the IT systems, as well.
Moderator: How will disease portals fit into the electronic records environment?
Buchanan: Last year, some of our staff was able to take all of our individual records for diabetic patients, and show it to us physicians, with a list, what is their last hemoglobin C? It was a very eye-opening experience for me and other physicians to see all of that data together. It showed what some of my average data is, and where I compare to other physicians. I can truly think about managing that pool of patients. It kind of pushes me to think in a systems manner, as opposed to the way that need to I keep thinking about an individual patient. So I think there is value that is going to flow from these data registries.
Kirschbaum: As we were preparing the implementation of our electronic medical records rollout, we did an inventory within UW of our freestanding registries. We thought we had a handle on it, and it was more than double what we thought. The strategy for us needs to be, how do we do a better job of embedding the kind of data that are of interest for better disease management and quality management within a registry frame built into the transactional data? And to create data stores, to analyze well, deploy tool sets that will allow or empower a distributed set of users to manage their own data rather than relying on a centralized pool. We have a long way to go. A lot of our focus just recently has been implementing the base requirements for the system. We have a great deal of work to do for folks to use this for better chronic care management.
Moderator: So a great deal of work needs to be done on the inside before it is made available to work on the outside.
Byrnes: I think one of the really interesting developments in IT systems that will have a huge impact, and perhaps confusing impact in the short term on health, are systems that are built on structured data, as opposed to unstructured data. The private sector, a la Google and IBM, is working hard on developing sophisticated systems for mining unstructured data, and their ability to produce knowledge out of that process may exceed the ability of people to mine information on a structured basis. If that happens, consumers will get their answers from an outlet like Medisystems than the information that is better than the information they get form their providers. The question is, will they trust it? This involves artificial intelligence systems. If it is really that good, it’s going to produce an answer that no one will believe, and that’s going to be one of the challenges that we are going to face in health care that we face sooner than anyone anticipates.
Moderator: As we move forward, the amount of stored medical information is going to become phenomenal. Who is going to maintain that data and be responsible for its accuracy? Who is going to own that data?
Kirschbaum: We’re implementing the Epic system, so we have a small group of insiders who touch and work with the Clarity analytical repository. We are only recently establishing a good infrastructure to begin to handle that one thing that we are advocating. What we don’t have is a Medidata curator – a person who will help us manage it. We would like to have a really robust store of Medidata, and a curator that really feels responsibility.
Byrnes: In the clinical domain, the principal financial support comes from the hospital system, itself, since they are paying for it, so they are feeling proprietary about the information, particularly when its in electronic form. When it becomes digitized, it becomes far more valuable because it can be manipulated, it can be aggregated, it can be used in ways that are far more valuable. At the end of the day, most of the digital data is going to be owned and supported by the clinics, and, I think patients will have rights and conditions to get that information, but only under certain terms and conditions. But they won’t own it.
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