Health IT Adoption Still Faces Big ChallengesHealth IT Adoption Still Faces Big Challenges

The U.S. government's nearly $20 billion health IT stimulus program will boost adoption among health care providers, but health industry CIOs say some huge hurdles lie ahead before the nation realizes significant payback.Among the health industry's biggest challenges are establishing and embracing standards for exchanging patients' clinical data among health care providers within communities, and across the nation, says Phil Fasano, CIO at Kaiser Permanente, the country's largest not-for-profit health plan.

Kaiser Permanente has spent the last five years rolling out KP HealthConnect to its 8.6 million patients and 14,000 doctors, making it the nation's largest civilian E-medical record system to date.

"The fact that [the nation] is moving more information to electronic records creates opportunity, but in sharing it you have value," Fasano said in an interview with information.

Yet, a lot of work still needs to be done with standards to allow valuable patient data exchange to happen, he says.

A few regional health information organizations-- or RHIOs-- have had some success in exchanging data among local health care providers in some states. But most RHIOs have had "mixed results," he says.

"We're in the very early days of connecting this data, there are many years of learning to come, Fasano says.

For its part, Kaiser Permanente expects to learn a lot more about clinical data exchange through a pilot program it's launched with U.S. Veterans Affairs to share patient data between KP HealthConnect and the VA's e-medical record system. There's "a high density" population of veterans and active duty military people living in Southern California, where the pilot is focused, he says.

KP has already learned other lessons about the challenges and potential of health IT. Some were learned the hard way, including through a few embarrassing glitches with its rollout of KP HealthConnect, among which were California power outages that prevented doctors from accessing patient e-medical records.

Yet, despite these assorted hiccups along the way, KP HealthConnect is already helping to improve the health of Kaiser Permanente patients, says Fasano.

Key benefits have come from Kaiser Permanent's use of patient health registries along with the e-medical records. Patients with chronic conditions like diabetes, heart disease, or a combination of chronic illnesses are more closely monitored with the help of the digitized health registries.

If, for instance, a diabetic patient fails to refill a prescription, misses a doctor appointment, or has any other "care gap," automatic alerts are triggered for Kaiser Permanente clinicians, Fasano says.

Outreach staff contacts the patient to find out why those gaps occurred and how to close them.

Meanwhile, in Kaiser Permanente's doctor offices, if a cardiac patient comes in to be treated for flu, the doctor will see an alert on the patient's e-medical record if the patient missed filling their heart medication prescription. "This is a preventative care system," Fasano says.

As a result of these health IT efforts, combined with changes in clinical workflow, many KP patients are already experiencing better outcomes. For instance, death from heart disease in Northern California among KP members is 30% lower than in non-members.

Besides implementing e-health records--and being able to share data with patients' other health care providers--another important piece to gaining value is studying the data to spot trends and develop improved best practices. "Once you've implemented e-medical records, you have to analyze the data to improve care," Fasano says.

Meanwhile, Lori Beer, CIO at health insurer Wellpoint, says health IT has huge opportunities to simplify costly administrative processes, but agrees the biggest return will be through improving outcomes for patients by providing doctors with more comprehensive information to make better clinical decisions.

As an insurer, Beer says WellPoint has a great deal of data to help round out information that's part of patients' comprehensive medical records. That's because as a payer of healthcare claims, WellPoint has a "big picture" perspective about the care patients are seeking from multiple providers, drugs being filled, tests being done. "EMR helps simplify processes, but the real power is in the integrated healthcare record, that includes data from physicians, payers, and the patients," she says.

The challenge in doing that is around standardization that can make this collaboration, interoperability happen, she says.

And while most are hopeful that the financial rewards doctors and hospitals are eligible to receive from the U.S. government starting in 2011 for using e-medical record systems will help boost adoption of health IT, WellPoint learned a few years ago that money isn't always the biggest driver for change among health care providers.

Several years ago, WellPoint offered its doctors free PCs or PDAs to help digitize their practices, yet thousands of the physicians passed on the offer.

Yet, Beer thinks the timing for financial incentives is better now, especially since more doctors today are already using technology tools for other aspects of their work and lives.

"More people use mobile devices, cell phones, Blackberrys for their day-to-day work today, even more so than just a few years ago," she says. That includes about 8,000 WellPoint contracted physicians using handheld devices and computers for e-prescription processes, she says. WellPoint has found that physicians using these e-prescription tools tend to make fewer medication related errors, stick to formularies more often and prescribe less costly generics more frequently, she says.

In any case, despite the hurdles ahead, the federal stimulus program should help get the ball rolling on more widespread adoption of technology to improve patient care and reduce costs.

"The incentives are a good down payment," says Fasano.

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