HMT: Evaluating ROI on EHR, usability of EHRs, healthcare spending rate low, and more
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January 8, 2014
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In this issue:

A standard model for evaluating return on investment from electronic health record implementation

Usability of EHRs remains a priority for ONC

Healthcare spending growth rate remains low

The potential in augmented reality surgery

Do you have what it takes to be considered “tech savvy?”

A standard model for evaluating return on investment from electronic health record implementation

The Institute of Medicine (IOM) Roundtable on Value and Science-Driven Healthcare views electronic health information as a pillar for the improved effectiveness, efficiency and safety of health care. Information is also fundamental to the concept of a “learning health system,” which IOM has described as having the capacity both to apply and generate scientific evidence in the delivery of care. While it is conceivable that such learning could occur without electronic health records (EHR), it is clear that the capacity the EHR offers to generate “big data” and thus a “collective memory” — from health care services delivered, resources used in that process, and patient and population health outcomes — would markedly accelerate improvement.

While the evolving transition from traditional fee-for-service to outcomes-based reimbursement, other forms of value-based purchasing (including networks restricted to higher value providers), and ultimately integration of clinical and financial risk would seem to make the need for provider implementation of EHR self-evident, the HITECH program demonstrates the need for external stimulus to accelerate EHR adoption. Perhaps a better understanding is needed of the relationship between investment and return to organizational efficiency, effectiveness, and sustainability.

A reluctance to adopt an EHR may have many reasons, including both the performance and cost of the EHR itself. Usability challenges complicate adoption, especially by physicians, and some arguments have been made that productivity can suffer. Provider resistance to adoption may also result from concern that financial benefits accrue disproportionately to payor organizations. In aggregate, slow adoption may represent concern that the business case for adopting EHR is poor. However, in the absence of data from comparable analyses, we have more opinion than evidence.

What do we, in fact, know about the provider return on EHR investment, which in this case is essentially a return on information? There are a number of studies that support a net benefit to provider organizations, exclusive of benefit to payors. There are also studies that show impairment to productivity and adverse financial impact. Despite many thoughtful analyses, the most compelling observation is that it is difficult to compare studies and to determine whether differences arise because of the technology and the manner of its deployment, or because of differences in the methods used to assess costs and benefits. That is to say, there is no standard model for assigning the costs and benefits of EHR adoption and, as a result, no standard or comparable business case.

Read the full Health Affairs article here

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Usability of EHRs remains a priority for ONC

The New Year is a time of reflection and anticipation. We reflect on what went well in the past (and perhaps what didn’t go so well); we anticipate future challenges and accomplishments.

As I reflect on the past, I can see that we’ve accomplished incredible things together. The majority of care provided in United States hospitals and medical offices is conducted with the assistance of information technology. Our care is safer, more efficient, and provides research and measurement opportunities that were simply impossible with paper systems.

But as a physician who has used an EHR in my clinical life since 2001, I worry that some of the usability challenges that we early adopters tolerated “for now” (a decade ago) remain unresolved.

This is a problem.

Early adopters of technology are well known to tolerate imperfections. Traditional market forces generally keep products that are difficult to use from succeeding, and as any user of an Apple Newton remembers, the promise of an innovative solution isn’t always realized and will/should fail in the marketplace. Yet some have argued that the meaningful use incentive program altered market forces in a way that prevents well-intentioned products from failing as did Apple’s first “personal digital assistant.” Health IT is not the same as consumer electronics:

a) The user isn’t always the buyer. This causes usability to be a less significant component of buying decisions.

b) Multi-year contracts and technical “lock-in” cause portability to be a true challenge. One can’t just walk away from an EHR that’s not performing as expected. Buying an EHR is more like buying an airplane than a clock radio.

c) Legacy software in a high-risk environment will evolve slowly – for good reason. One can’t change workflow or user experience too quickly, as changes in the user interface can increase error rates even if the new design is better for new users. Errors can harm or kill people. Developers need to evolve user experience slowly and carefully. Usability won’t improve overnight.

Read the full Health IT Buzz article here

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Healthcare spending growth rate remains low

U.S. health care spending grew more slowly than the economy as a whole in 2012, according to a new analysis from the Centers for Medicare and Medicaid Services. Overall health care spending increased at a rate of 3.7 percent to $2.8 trillion in 2012, marking a fourth consecutive year of slow growth and relative stability in cost increases, industry journal Health Affairs said.

Growth in health care spending since 2009 has occurred at the slowest rates recorded in the 53 years that the data has been recorded, according to the report, which is published in the January issue of Health Affairs.

The share of the U.S. economy devoted to health care fell slightly from its 2011 level of 17.3 percent to 17.2 percent in 2012. Faster growth among some health care services was partially offset by slower growth in other areas, said Anne Martin, an economist in the Office of the Actuary at CMS and lead author of the report.

Read the full Business Record article here

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The potential in augmented reality surgery

University of Alabama at Birmingham orthopedic surgeon Brent Ponce, MD, compares the augmented reality technology used during a recent shoulder replacement surgery to the technology that shows at-home football viewers the first-down and scrimmage lines on their TVs.

“The technology puts your hands in the surgical field like line markers on a football field,” he says. “They’re not really there, but you can see exactly where they are.”

The technology he’s describing is called VIPAAR, short for Virtual Interactive Presence And Augmented Reality. It was developed at UAB less than 10 years ago, and allows for real-time, two-way, interactive video conferencing.

During the Sept. 12 shoulder replacement surgery using the technology, Dr. Ponce wore Google Glass, which allowed a live video stream of the surgical field to be sent to his colleague, Phani Dantuluri, MD, in Atlanta. Dr. Dantuluri was able to offer a virtual hand by using the VIPAAR platform to superimpose a projection of his hands onto the heads up display of the Google Glass.

The shoulder replacement surgery was just a trial of using VIPAAR along with Google Glass — as an experienced surgeon specializing in shoulders, Dr. Ponce did not require Dr. Dantuluri’s assistance for the procedure. However, it provided Dr. Ponce with insight into the potential uses for a technology he had been testing out for a while.

At the Birmingham VA Medical Center, Dr. Ponce had conducted a prospective study using the VIPAAR technology during 15 shoulder arthroscopies. The procedures were performed by third- and fifth-year residents, with Dr. Ponce monitoring the procedure remotely from the surgeon's lounge, able to virtually put his hands in the surgical field when needed or to point out a structure or potential issue.

To Dr. Ponce, being able to remotely (and sterilely) place his hands in front of the residents allowed him to communicate better than if he was in the OR physically. "When I'm next to the resident, I have to stop the case to show them something or use directions like 'on the right' or 'five o'clock,'" he says. Using VIPAAR, he is able to demonstrate proper technique by moving his own hands and point out structures or the next destination exactly without having to describe it verbally. "I found I can communicate more effectively remotely," he says.

Read the full Becker’s Hospital Review article here

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Do you have what it takes to be considered “tech savvy?”

For the last 34 years Health Management Technology has been exploring and chronicling the growth and development of computers and other technologies used in healthcare organizations to provide high-quality patient care.

This year we’d like to shine a klieg light on those hospitals, hospital systems and integrated delivery networks (IDNs) that make optimal decisions about the tech they need and want (in that order) and use it effectively and efficiently. We’re not just looking to recognize those organizations with deep pockets and a fiscal war chest that allows them to stock up on all the latest tools and toys. Instead, we’re looking to recognize those facilities that make optimal use of the tech they have – leaving few capabilities ever untouched – whether large or small, cash-full or cash-strapped.

What makes a provider organization “tech savvy?” What they’re doing and why they matter in the areas of cost-conscious, efficiency-driven, clinically motivated and patient-centric concepts, ideas and activities that can generate quality outcomes.

Here’s where we need your help. Within your organization or within your customer base, who’s using technology and how are they using it to do top-notch, innovative work? We plan to publish mini-profiles of these organizations in HMT’s March 2014 edition, relying on your nominations.

1. If you were to look at your current customer/membership roster, what are the top five hospital, hospital system and/or IDN organizations you’d recommend we consider for this list? (Please provide the organization name, city, state and proper contact information, including name, title, email and telephone number, for each of the five organizations you nominate.)

2. For each of your recommendations, please highlight a few bullet points and/or sentences why you believe this organization’s operation measures up to being “tech savvy.”

We’re going to collect the recommendations and evaluate them based on their “nominations.” Please note that you or your organization will not be identified as nominating the organization, but if a number of your organizations make the list you’ll certainly earn some bragging rights. At the end of the “official” list we will ask readers to submit organization names that should have been on the list and that we should consider for the 2015 compilation.

Please submit your recommendations to HMT via email no later than Monday, January 20.

Feel free to pool as many folks within your organization for recommendations as you’d like. As always, we appreciate your help and insights and look forward to sharing them with our valued readers.

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