Kent Bottles: Why is HIT So Important for Health Care Reform?
I spent a delightful weekend facilitating the Medical Staff/Board Retreat for St. Mary’s Hospital in Grand Junction, CO. I was pleased to be asked to come to Grand Junction because like Minnesota, this community is clearly the anti-McAllen, TX when it comes to providing high-quality, low-cost health care. In fact, my hosts had just had visits from both President Obama and a medical delegation from McAllen.
I learned during my visit are that this part of Colorado only gets seven inches of rain a year and grows fantastic peaches. I can attest to their quality as they were served as both appetizers and desert at dinner. I was also surprised to learn that wineries are now operating in and around Grand Junction.
The retreat focused on how to engage physicians in the adoption of a new health information technology (HIT) system for the hospital. I led a spirited discussion on why hospitals like Saint Mary’s need to continue to embrace HIT.
An article by Robert E. White in the Journal of General Internal Medicine (J Gen Intern Med 23 (4): 495-9, 2007) provided an interesting way to provoke discussion. White states that a new paradigm embracing information technology may be needed to replace our current model of highly trained, autonomous individual physicians who ply their trade through distinct patient encounters.
White postulates that American health care is challenged in the areas of knowledge, prevention, quality, cost, and manpower, and he believes that HIT can help in each of these problem areas.
The challenge of individual physicians coping with the quantity and complexity of medical knowledge is well known. White notes that the primary care physician would have to devote 25% of their time counseling patients about the U.S. Preventive Services Task Force preventive health practices and another 25% conducting screening tests. When I asked the chief of family practice in Grand Junction, she said that was about right and that nobody has the time to do that in a busy clinical practice. The articles I have read in the past that say about 6,000 new medical journal articles are written a day and that Americans only receive 55% of recommended care also relate to this problem. An HIT system could help clinicians with these challenges.
White also notes that we have not done all that well in making sure that all patients over 64 years old receive vaccination for pneumococcal disease, with the national mean being 64% in 2004.
In the area of quality, White believes that HIT could help with the problem of missing historical and test documentation that occurs in 14% of primary care visits. He also states that HIT can certainly help with guideline adoption and implementation.
HIT can aid cost containment by eliminating redundant test ordering due to unavailability of old charts and the one in seven hospital admissions related to not having all prior patient information available.
HIT can help with the manpower problem by providing rules-based guidelines for nurse practitioners and physician assistants when primary care physicians are unavailable due to supply or cost for a medical care system. Clay Christensen in the Innovator’s Prescription certainly thinks that HIT and personal health records are key components of disrupted medical care systems.
By talking about these challenges, we generated a lot of discussion about how Grand Junction medicine will change in the future with HIT. We also touched upon how new technology will “unleash new ways for patients to use computer-based, training, questioning, and advising, that results in shared decision making without formal clinical encounters. This concept of Health 2.0 or Participatory Medicine was a new idea for many of the participants, and some were eager to anticipate how it might affect their practices.
I learned from informal discussions during the breaks how the Sisters of Charity of Leavenworth Health System was using consultants to think about how health care will be delivered in 2020. Mary Jo Gregory, the System COO, and I had a conversation that really made me think about the future. I was impressed by the trust that the Board and the medical staff have in John Beeson and Bob Ladenburger and the entire Senior Leadership Team of St. Mary’s. Board members Dan Roberts and Bob Bray gave a dose of business reality, and Kristy Reuss, RN, PhD, told us how much her nursing students are demanding a new way of learning that heavily uses social media like Facebook and Twitter.
I really do get a lot out of these ICSI consulting engagements, and I learn as much as I teach. Next week it is off to Washington, DC to be faculty in the Governor’s Association Conference on HIT.
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