Is it finally time to smash data walls between providers? Can health care afford not to?
HIT Exchange Magazine features an interview with Ascendian CEO - Shawn McKenzie
Few hospitals have not made budgetary commitments to healthcare IT. However, the rationale behind IT investments has always been somewhat scattershot. Five to seven years ago, it was sometimes driven by a notion that IT investment was the right thing to do, based on then-nascent evidence about improved quality and safety. Others thought it was a way to get ahead of the competition. Some simply wanted to be first.
Federal healthcare reforms pushing IT investment have changed the strategic drivers. But are the government's carrots and sticks the main motivators behind continued IT investment? Is patient safety still the best reason to commit capital budget to healthcare IT investment? Is competition the issue, or is it operating efficiency?
The industry analysts, consultants, and healthcare executives queried by HIT Exchange generally agree: It's all of the above. But beyond that—it's a question of survival.
The federal government has threatened to reduce Medicare payments to hospitals that fail to achieve Stage 3 meaningful use of certified electronic health records by 2015 – a goal complicated by the fact the government has yet to map out a path to anything beyond its Stage 1 criteria.
"There are no ifs, ands, or buts about it," says Mike Davis, a managing director at Washington, D.C.-based Advisory Board Co. "If you don't have the appropriate automation, you're not going to be able to compete."
Shawn McKenzie, president and CEO of Ascendian Healthcare Consulting in Sacramento, Calif., agrees. The wild, wild west fee-for-service reimbursement model is rapidly falling out of favor with both governmental Medicare and Medicaid payers and with commercial payers, he says. It soon will be incumbent on hospitals to understand and measure their true costs and find ways to prune back—and that will require sophisticated system automation.
"I hate to be Chicken Little and say the 'sky is falling'," McKenzie says. "But I think that if these IT systems aren't in place, and if you can't engage in that episodic pay structure because you don't have interoperability, it could be a major blow to the organization."
Federal healthcare reforms pushing IT investment have changed the strategic drivers. But are the government's carrots and sticks the main motivators behind continued IT investment?
Such urgency is felt throughout the industry, which features widely variable rates and levels of hospital IT adoption, particularly on the clinical side.
Researchers at Chicago-based HIMSS Analytics have formulated an Electronic Medical Record Adoption Model (EMRAM) scoring system for hospitals. An EMRAM score of zero means an institution has failed to implement even basic ancillary lab, radiology, and pharmacy systems. A score of 7 indicates an institution is fully equipped to handle continuity of care document transactions, deep-dive data warehousing and mining, full physician documentation and clinical decision support, and fully fledged CPOE, among other rich applications.
Most of the 5,310 U.S. hospitals surveyed fall somewhere in the middle of the scale. As of the second quarter of 2010, the median EMRAM score for all U.S. hospitals was 3.2. That means that while many hospitals now have automated nursing documentation and clinical decision support, most are not yet in line with the government's Stage 1 meaningful use mandates, which require CPOE. This application is also a requirement for achieving an EMRAM score of 4 or higher.
New England ranks highest regionally with a 3.4 aggregate EMRAM score. The West South Central portion of the country including Texas, Louisiana, Arkansas, and Oklahoma ranks lowest, with a regional score of 3.1 Though scoring slightly higher in the aggregate, only the East South Central region of the United States—Kentucky, Tennessee, Mississippi, and Alabama—has no hospital with an EMRAM score of 7. Throughout the country, academic hospitals generally score higher (median 4.2) and rural hospitals rank lowest (2.15).
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