April 2009 | www.healthmgttech.com | Issue 4
	The Change Healthcare Needs Change is rarely easy, but often, it is necessary. By John Shagoury

As a new administration settles into the White House armed with conviction, experience and technological know-how, there’s an air of doing well and doing right. At the forefront of priorities, along with the current economic downturn at hand, is the need to streamline the healthcare system and make quality, affordable healthcare a reality.

As part of President Obama’s economic stimulus package, he’s pledged to have all medical records electronic within five years. That’s not a lot of time when you consider the fact that only 25 to 35 percent of the nation’s 5,000 hospitals use computerized order entry and medical record systems. Moreover, there’s already been outlash from the medical community in regards to the financial and time-related costs associated with this change. There’s a quote from Charles Darwin that speaks to the issue of change: “It is not the strongest of the species that survive nor the most intelligent, but the one most responsive to change.”

As we accept change as a necessary part of life, the question remains: How can we make the transition to electronic health records (EHR) efficient and effective?

Healthcare IT Vendors —– A Ray of Hope?
Healthcare IT solution providers can play a larger role in the EHR initiative by supporting the delivery of their technology solutions with realistic ROI expectations, and even more importantly, adequate and ongoing training. For digitization to come to fruition, solution providers must be responsible and sell their technology in a meaningful way. This means that the collective goal of healthcare organizations and vendors must be improved patient care. With the application of operational solutions that significantly enhance the way doctors capture a patient encounter, the industry as a whole can look forward to better documentation with fewer errors, improved caregiver communication and faster access to patient information.

Ultimately, the success or failure of EHRs will be determined by their impact on patient care — improved outcomes, lower adverse medical effects, reduced healthcare inflation and clinician satisfaction. EHR solution providers may see a surge in sales given the government’s agenda to go digital, but to be successful in the long run, vendors must carefully observe physician-EHR interaction and workflow, modifying the technology to promote utilization.

According to Dr. Garber at Fallon Clinic in Massachusetts, EHR software only amounts to about 20 percent of the cost for implementing an EHR system, and the remaining 80 percent needs to be accounted for training, building the system, medical record conversion and optimization, as well as additional investments to ensure utilization. Once an EHR is up and running, healthcare organizations and vendors need to ensure doctors use it to facilitate better care, not just to comply with government regulations or other pressures.

Controlling Costs with Advanced Technology
Approximately $10 billion is spent on medical transcription in North America every year, and with advanced technology this cost can be significantly reduced. Doctors can use real-time speech recognition software to dictate directly into an EHR system, eliminating the need for any transcription to finalize medical reports. Or, if doctors don’t want editing responsibilities, they can opt for zero workflow disruption by leveraging background speech recognition to dictate into a phone, dictation device or EHR to create high-quality drafts that medical transcriptionists quickly review and edit for them. Either way, the $10 billion spent on traditional medical transcription is slashed, and the lag time it takes to turn around medical reports is improved. Beth Israel Deaconess Medical Center in Massachusetts uses speech recognition software as part of the process to input data and physician narrative into their electronic medical records and since 2002 has saved $5 million in transcription costs.

By adding speech recognition to the process, physicians experience decreased reliance on typing (the keyboard), enabling them to spend more time practicing medicine and up to 25 percent less time documenting care; they also reduce reliance on (and limitations created by) point-and-click templates, a major driver to cookie-cutter patient records that lack patient-specific details.

High-tech diagnostic imaging is another area where costs can be reclaimed with the use of advanced technology. The current overall cost of diagnostic imaging is estimated at well over $100 billion annually in the United States. The industry can better manage diagnostic imaging order habits to reduce unnecessary spending in this area. While leveraging electronic ordering (“e-ordering” or point-of-service decision support systems) to help qualify the appropriateness of high-cost medical imaging exams is a relatively new concept, the need to validate the medical necessity of a procedure, as well as gain insurer preapproval for payment, is becoming increasingly clear.

Caregiver Communication Pitfalls
Shortcomings in the area of caregiver communication are a common cause of issues associated with poor patient care, time management and overall costs. Radiology and lab departments in particular struggle with communicating patients’ critical findings. Typically, radiologists and lab technicians waste precious minutes — even hours — trying to track down the responsible caregiver, verify that the critical message is received and document the communication. Communication barriers stall the time it takes for the patient to receive actual care. In fact, in 2006, nearly two-thirds of the hospitals surveyed for accreditation purposes by the Joint Commission were cited for failing to meet the requirements of the National Patient Safety Goal to improve the effectiveness of communication among caregivers.

Two to 3 million phone calls related to patients’ critical findings are made each day. This excess of calls often leads to critical communication drop-offs, leading too often to malpractice cases. With critical test result management (CTRM) automation, hospitals (and patients) can rest assured that critical findings are automatically delivered to the appropriate caregiver despite shift changes, missing contact information, outages or unavailable messaging services. Additionally, with CTRM in proper operation, facilities achieve Joint Commission compliance.

Nobody Said Change is Easy
With all of this in mind, it’s important to discuss what it’s going to take to make change a reality. Now, more than ever, there is a focus on the strength and importance of team-oriented efforts. As we face the seemingly daunting task of transitioning to EHRs, speech recognition, electronic ordering, automated communication and other advanced technologies, it is crucial that healthcare IT solution providers partner with healthcare organizations to collaborate for the effective deployment and use of these solutions — and one thing we all must remember is the tried and true saying, “nobody said change is easy.”

John Shagoury is president, Healthcare Division, Nuance. Contact him at john.shagoury@nuance.com.

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