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Thoughts, comments, news, and reflections about healthcare IT from Microsoft's worldwide health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.

A Chance to Sound Off: What's Ailing Healthcare?

A Chance to Sound Off: What's Ailing Healthcare?

  • Comments 7

This morning it was my pleasure to attend a Healthcare Advisory Committee Meeting hosted by our 8th District US Congressman for Washington State, Dave Reichert.  Congressman Reichert is perhaps best known as King County Sheriff, Dave Reichert, who helped bring the infamous Green River Killer, Gary Ridgway to justice.  These days Congressman Reichert is especially passionate about healthcare.  Twice each year he brings together a small group of regional healthcare leaders to tell him what's on our minds.  The group consists of hospital CEOs, health plan executives, health educators, professional association leaders, and consultants including one or two of us who speak on behalf of information technology in healthcare.

The Congressman told us he primarily wanted to discuss issues dealing with the new Medicare Part D Prescription Drug program, issues related to government mandates that made healthcare delivery more burdensome, issues about information technology adoption in healthcare including concerns about privacy and security, and health care insurance issues such as the growing trend towards healthcare savings accounts.

A retired physician executive on the committee immediately raised alarms about the growing federal deficit and five grossly under funded entitlement programs; Social Security, Medicare, Medicaid, Military Health and the VA.  Everyone knows these programs are a train wreck waiting to happen, but Congress appears unwilling or unable to do anything about it. Following some debate on that, each person on the committee spoke on behalf of their favorite vested interest and asked how they could get more federal money for their programs.  I got a bit of a laugh when I pointed out the irony in what had just taken place.  We had proclaimed our deep concerns about the growing federal deficit and unfunded entitlement programs, and then gone around the room asking for more handouts.  Go figure!

During the time I had to address Congressman Reichert, I commented on the need to simplify and clarify HIPAA regulations so that hospitals and healthcare providers would be more willing to share information with those who need it most; caregivers, patients and family members. It seems absurd that we often can't get or share the information we need to take care of our loved ones or render care to our patients let alone be able to communicate and collaborate on their care in a timely, efficient manner.  I also raised concerns about how far the US is falling behind other countries in the implementation of information technologies in healthcare.  We spend more money per person on healthcare than any country in the world.  We also squander a heck of a lot of it because of the inefficiencies and waste in a "system" that still does its business largely with paper forms and ink.  Congressman Reichert strongly agrees that we have the necessary technologies to fix this.  But do we have the will?  Furthermore, think how much money we could save if technology helped us deliver the most appropriate level of care to people exactly when and where it was needed.  Why in this day and age do I need to make an appointment and drive somewhere to get even the most basic services from a healthcare provider?

If you have something you'd like to pass along to our leaders in D.C. leave me a comment.  I'll pass it along to Congressman Reichert.

Bill Crounse, MD   Healthcare Industry Director   Microsoft Healthcare and Life Sciences

  • I think that adoption of technology is not the problem. Docs will adopt if it helps them: epocrates on the handheld, med devices etc.
    There are two main problems with IT in healthcare that no one has clearly addressed on a large scale:
    1. IT brings little to no tangible value (hard quantifiable data)
    2. IT negatively impacts user workflow and it really does not create incentives for users. The beneficiaries of IT are mostly insurers, administrators, and patients. Not the physicians, nurses etc.

    Solving these issues will go far to create a much stronger interest in getting IT adopted. My strong opinion is that at the bottom of these problems is finding out how to model complex and dynamic workflow correctly. Once you have that you can actually optimize process. We are doing this sort of work.
    Anwar
  • Thanks Anwar. I agree that docs will adopt technologies that provide a tangible benefit and resist ones that don't. Furthermore, while I agree that many of the benefits of an EMR do accrue to insurers, administrators and patients, I've read lots of case studies from practices that are reaping huge benefits from going electronic. Taking care of patients is all about communication, collaboration and documentation. Today, there are better tools for doing this than pen, paper, fax and telephone. Data input remains a challenge for docs, but you've got to admit that things are getting a whole lot better on that front too. And yes, technology won't fix fundamentally flawed workflow process. We need solutions that address both sides of the equation.

    Bill Crounse, MD
  • I agree that IT is capable of helping MDs practice more efficiently. The prices on ambulatory EMRs have decreased significantly even as their reliability and functionality have improved.

    The biggest problem is still interoperability. Why should a smaller practice invest in EMR if that application cannot interoperate with the hospital, other providers or lab services? The question remains - will CCR or HL7 provide true interoperability and mitigate vendor lock-in? Will the market allow such a 'ground-leveling' approach?





  • Thanks for your comment, Gonzo. I agree that fear, uncertainty and doubt about ISV standards harmonization is holding back the market. However, Brailer's office is sponsoring work on standards harmonization and a certification process for EMR vendors. The HIMSS IHE (Integrating the Healthcare Enterprise) committee is engaging with "leading medical professionals and associations from other key domains and identifies integration needs, barriers, problems and solutions to speed up the rate and quality of integration in healthcare environments". Other legislative initiatives like the one announced today that would move 9 million federal employees to an integrated EMR sponsored by health plans will also help. Within 5 to 7 years, it may no longer be possible to practice medicine in the US and get paid for it without using an EMR.

    Bill Crounse, MD

  • I think you hit the nail on the head when you said that there needs to be clarification on the HIPAA regulations. I believe that a huge part of the fight for Doctors turning to EMR is not understanding the impact HIPAA has on them in the electronic world. They feel comfortable with paper since they feel like they know how it applies.

    Just today I spent I don't know how long explaining why not sharing passwords, not writing them down and having separate username and passwords is very important in a digital world. I still don't think they got it. They just don't understand the security implications of an electronic world.

    John
    http://www.crashutah.com/emr
  • Reposted from my blog.

    Ok so here is a main problem related to IT that I have seen. It’s the attitude of the IT department itself. For some reason IT departments at many institutions, not all, have the idea that they are performing a service for the doctors and that it is a privilege to be allowed to use the hospitals IT systems. For instance a Doctor at one institution I am familiar with has a network sign in, an EMR sign in, an order entry sign in, a PACS system sign in and at least one electronic signature code. And that’s just at one hospital in the system. Multiply that by 5 and a physician may need to remember 25 logins just to do their basic job. I feel for the physicians not the IT people with logins and password management. There is no way that doctors can be expected to remember 10 logins much less the dozens that would be required if they had a different one for every system. So in a sense we have self created single sign on because they use the same password everywhere. Also they are constantly forced to change their passwords. So since passwords are just one thing they have to remember they write them down. In addition in the name of security there are often so many regulations that physicians are reluctant to adopt IT systems.

    Consider the following. In a teaching hospital doctors often rotate through different hospitals each with its own computer systems, access codes, and policies. At one hospital they disable an account after being inactive for three months. So if a doctor comes back on a rotation their account is disabled. Of course they don’t remember the number for the help desk to get their account unlocked. So they either just have someone else enter the notes or use someone else’s login. This is an example of security policies hampering the workflow.

    IT departments need to realize that they are critical infrastructure, not some nice service that the hospital gives its doctors. IT people do things like role out wireless networks and then don’t let anyone else use it. They kick and scream when departments need to tie into HL7 feeds.

    So that’s my 2 cents about healthcare IT. If you want the real problem with healthcare it’s that it does not behave like a free market. Medicare/insurance skews the market, degrades competition and causes over consumption and high prices. I just spent a few months with a healthcare economist and I am convinced that Health Savings Accounts that operate like 401Ks would be the answer. Allow people to keep their money from year to year and allow the money to be conservatively managed and tax exempt (or some form of tax preferred status). So phase out Medicare and let the insurance companies die. But this will never happen. Mostly because of politics and most people don’t know healthcares dirty little secret, all the healthcare spending produces very little in real actual health.
  • Steve,

    Once again, we are mostly in agreement. I'm always fond of saying that there is no such thing as an IT project. IT is only the facilitator of projects. Projects must be owned by the lines of business that sponosr them. I've written extensively about the need for a common clinical user interface , and have also pointed out that there is no way clinicians can learn to use a different proprietary system in each hospital where they round or work. Likewise, with the password and sign-on issue. If you listened to President Bush last night, then you know that HSAs are in our future. So, the tide is turning, albeit too slow for some of us.

    Bill Crounse, MD
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