From the impact of HITECH to the industry's perception of healthcare IT, our panel of experts weighs in on some heavy issues:
The federal government's role in healthcare IT continues to evolve; where do you see it heading after a couple years of HITECH implementations? Will a single, lead certification and standards entity emerge after the HITECH dust settles?
Daniel O'DonnellAs with any large-scale initiative, there will be both anticipated and unanticipated consequences. An anticipated consequence will be that these initial efforts will not be adequate for widespread adoption and effective use to truly coordinate the care of the majority of complex patients. I suspect that an unanticipated consequence will be the need for significant payment-system and medical-cultural changes. Technology currently available, but not yet widely used, is capable of enabling truly coordinated care. But time required for real coordination is not compensated, and medicine is not yet a team sport.
Justin BarnesI certainly see the roles of CMS and ONC as ongoing enterprises, as the administration of meaningful use continues through Stage 2I suspect that the HHS role will become more of a stewardship as CMS and ONC oversee these stages of updates and maintenance which are already planned through the next decade. Throughout this process, it will remain important for private sector collaboration to remain intricate for the success of any of these programs, processes and policies.
I agree with ONC's vision that the private sector administers certification when the permanent certification process rolls out in the near future, although ONC will still have a hand in oversight and must provide necessary transparency to the transition and process. Ultimately, we'll have to see what market forces prevail. I think I can safely predict that CCHIT will emerge as one of the first, if not the first, ONC-ATCB, which will bring some short- and long-term stabilization to the process.
Jonathan TeichLauren Bellon
Although the final ruling on meaningful use provides a clear HIT path to follow, it seems the [journey] is bound to be a slow one. And it may not be a path that leads to ultimate HIT nirvana.
Whether one or many bodies of certification and standards emerge, the bigger challenge is that a certified EMR does not guarantee meaningful use.
Betty Otter-NickersonAs a result of HITECH, all EHRs are required to be functionally equivalent to be certified. Past the initial certification for baseline functionality, the need for further certification will decrease as the focus turns in Stages 2 and 3 from fostering adoption to fostering interoperability and eventually analyzing and improving outcomes.
Tom StephensonKelly Feist
The HITECH Act, as it is written, is intended to drive the increased adoption and utilization of healthcare information technology. The expectation is that this increased adoption will have the subsequent impact of improving the quality and decreasing the cost of care delivery.
As the single largest payer for healthcare services in the country, the federal government stands to gain significant benefits if the clinical and economic expectations of meaningful use are realized.
Doug BilbreyInformation technology has often been viewed as a cost center, a necessary negative and, in some rare cases, evolved to acceptance as core to healthcare's future. What have you seen in the evolution of IT as it is perceived and embraced by healthcare provider organizations?
Jonathan TeichAggregation and sharing of internal data, including the ability to make sense of it in a way that improves efficiency and quality, is becoming a focus of provider systems [with] extensive but non-interoperable
We do a lot of business around the world directly with provider organizations, including government-managed delivery systems, in more than 20 countries and in many languages. Our customers in other countries are not affected by the ARRA HITECH incentives, but they are strongly affected by the same core business needs: greater efficiency and improved clinical outcomes. This is true internationally regardless of the nature of local payment systems. In many ways other countries — for example, Scotland, Chile, Brazil and Thailand — are showing how very large-scale, patient-centric HIT systems can enable care coordination, clinical outcome improvements and cost efficiencies.
Lauren BellonAs systems improve and clinicians have the data they need when and where they need it, continuity of care across providers evolves. We can finally realize improvement in quality of care and access, increased patient safety, enhanced patient-focused records and increased safety and efficiency for healthcare providers — and all at a time when more patients are being added to the system through healthcare reform.
Justin BarnesOrganizations will embrace a technology that fits their needs and offers usability that matches work flows. If those standards are established up front, practices and hospitals have been shown to experience robust ROI, and healthcare information technologyI think the industry expects more acceptance as the provisions of ARRA and the HITECH Act take hold. I think we've all seen encouragement by the early adoption and movement being seen by the regional extension center (REC) programs, for example. And finally, I think that these acts are furthering the understanding that standards-based interoperability can also be a driver of acceptance as practices realize they can exchange data internally and externally to satisfy stimulus programs, pay for performance measures and advance interaction with patients.
Betty Otter-NickersonHealth reform is driving reimbursement to a quality-based model and driving clinical HIT as a mechanism to manage reimbursement. In the case of financial practice management, HIT has been overwhelmingly adopted because a clear ROI can be demonstrated — provider organizations can essentially not survive without it. When the same can be said for clinical IT, it will gain the same level of acceptance.
Tom StephensonOur customer base is community hospitals and they still view IT as a necessary negative because of the capital cost and the challenges with changing work habits among staff and physicians. For those hospitalsLaboratory test results are among the most requested pieces of information by all constituents within the healthcare value chain.
Doug Bilbrey
The emergence of the personal computer and the transition from the mainframe computer system to server-based applications brought an entire new suite of applications to healthcare providers that penetrated all facets of the delivery and administrative areas of healthcare IT. This has profoundly affected the embracement of technology by all users in provider organizations.
IT is now one of the most important departments in the healthcare enterprise, and I cannot imagine any provider not appreciating the impact IT has had on the improvements described herein.
Daniel O'Donnell
M.D., senior advisor, medical informatics, InterSystems
Lauren Bellon
vice president, healthcare solutions and strategy,
Perceptive Software
Kelly Feist
vice president, marketing, Sunquest Information Systems
Justin Barnes
vice president, marketing, corporate development and government affairs, Greenway Medical Technologies; chairman emeritus, Electronic Health Record Association
Betty Otter-Nickerson
president, Sage Healthcare Division
Jonathan Teich
M.D., Ph.D., chief medical informatics officer,
Elsevier Health
Tom Stephenson
CEO, Healthcare Management Systems
Steve Emery
director of product management, HealthPort
Doug Bilbrey
executive vice president, sales and marketing,
The SSI Group