HIT me

Through the adoption of electronic health records (EHR), providers across the country are bringing our nation’s health care system into the 21st century.  EHRs are designed to pool all of a patient’s health information into one computerized record such that primary and specialty care, hospital stays, ED visits, tests, and prescriptions are easily accessible and  shared across provider settings.  Electronic records are intended to prompt physicians when preventive screenings are warranted; manage prescriptions and ensure against negative interactions; support proactive chronic disease management and interventions; help coordinate care among and between different providers; and provide safer, less duplicative, less unnecessary care.

But implementing an EHR system is no easy task.  It’s expensive.  And it tends to disrupt the work flows that follow paper charts, requiring new ways of delivering care, interacting with patients, and managing business processes that can be daunting to providers, front office staff, billers, and managers alike.

This makes me think of a quote that Senator Ted Kennedy’s widow shared at a conference I attended last year.  She said it was a favorite of his.  That is, “for every difficult, complicated  problem there is always a simple and easy solution.  And it’s WRONG.”  EHRs are a little like that.  They offer a complicated – yet essential – solution to help achieve the challenging goals of higher quality and lower costs.

The class of 2012 is fortunate to have a HIT-whiz among us:  Rami Rafeh.  Below are some HIT questions I posed to Rami, along with his responses.

Tell us a little bit about how the Obama administration is attempting to incentivize the adoption of electronic medical records across the country.  What progress has been made?

Under the Health Information Technology Act (or HITECH, enacted as part of the 2009 federal stimulus bill), a physician can get upwards of $44,000 in incentives to update their practice with an electronic medical records system.  They must also report on certain quality and other metrics moving forward, to show that they are using their electronic systems in “meaningful” ways that are improving patient care and outcomes. (The ONC says that 41% of private physician practices are planning to achieve meaningful use of EHR, and a third of them will do so this year.)  Another component of HITECH will establish regional information exchanges (RHIOs) and other network enhancing interfaces.  There is also an education component which provides training for 50,000 health information employees to prepare for the new demands of this exciting field.  Columbia saw its first cohort graduate last semester with many students receiving subsidized tuition by the federal Office of the National Coordinator at Health and Human Services.

One of the big problems with the way electronic health records is unfolding is the fact that all these programs can’t talk to each other. So my pcp can’t get feeds from the ED which can’t get data from the lab etc, etc. Aren’t we simply building more electronic silos and where does this eventually get us?

The real foundation of what the Health IT movement is all about is interoperability.  The way I look at upgrading an existing network is like changing the wheel of a car while it’s in motion.  We have found that even in the same organization, you can have upwards of 1200 interfaces (components that try to make different systems ‘talk’).  Our current network is so complex and the information is just too sensitive to simply start over.  This is why some capital budget projects are +40% Health IT.  HL7 is a language that creates a standard for health systems to communicate with one another, but so much work is already out there with hundreds of different vendors, it is pretty much like installing Windows on a Mac.  The hope is that as we are training our professionals better, they understand the existing problems and can set up a framework that promotes interoperability and at the same time become silo-busters.

It also seems like there´s a tendency to view health information technology as the solution to health care problems (inefficiency, poor quality, etc).  But aren´t these problems really caused by – and solved by – people?

Absolutely.  I think at times we tend to over-exaggerate the outcomes that Health IT offers.  As we always say in industry: garbage in, garbage out.  We have not gotten to the point yet where computers can intelligently clean up our data.  Health IT does offer a way to identify work stream inefficiencies, reduce redundancies when properly executed, and set up a framework for sharing health information across multiple computers whether within the same service line or across different organizations.

Tell us a little about the program you just completed (in conjunction with your full time job and EMPH, I might add)?

The program is six-months in duration and provides students with the practical knowledge and skills required to use electronic health records (EHRs) in health organizations. The program aims to train each individual for one of three roles defined by the Office of the National Coordinator (ONC): 1) Privacy and Security Specialist, 2) Programmer/Software Engineer, and 3) Health Information Management and Exchange Specialist (where I focused).  It was very exciting, and I liked it so much that I am assisting teaching this semester selfishly so that I can stay close to the material.

Why are you so passionate about HIT?  What´s your dream job?

I never really understood why, as a kid, I was so completely engaged in computers the way I was.  My mother told me that I was born with a mouse in my hand, so it was only fitting that I continue down that path.  I think the thing that excites me about Health IT is that it requires such strong leadership, a strategic mindset, and a lot of creativity if you can believe it or not.  What we don’t need right now is more of the same, but rather more of what I like to refer to as change champions.  My ideal job would be to work with a dream team like Farzad Mostashari from ONC, Todd Park from HHS, and other visionaries that just will not settle for status quo.

If you were to recommend one article or report or website about HIT that we should absolutely read, what would it be?

I would love to give you an article that ‘sums’ everything up, unfortunately there is so much conflicting data out there that even to this day, I’m still learning.  What I did find helpful was a book that gives you a very good foundation in what is going on in this country regarding the health IT movement, and coincidentally was written by an EMPH alum, Ken Ong: Medical Informatics: An Executive Primer, Second Edition.

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