The cost of integrating electronic health record (EHR) technology into a hospital or ambulatory facility can be daunting, especially if the organization is not close to meeting Stage 1 of the criteria for meaningful use.
The costs of not going electronic leave little choice, however. Medicare reimbursements are lower if an organization doesn't comply with the Health Information Technology for Economic and Clinical Health, or HITECH, Act, and the cost of managing -- or just keeping -- paper records on file is prohibitive. That's why selecting new health care technology powerful enough to fulfill these disparate needs is high on the agenda of many health care organizations.
"There are pieces of paper all over the place having to be filed," said Dr. Alan Gorenberg, an allergist in Victorville, Calif. "They take away people's time in filing and looking for information in the charts."
The path to such new health care technologies as EHR has many forks -- among them, how to deploy an EHR infrastructure and where to start. Most medical organizations, even if they're still using paper, already have some technology in place. Desktops, printers, and such networking gear as routers and switches can be repurposed for practice management systems, data interchange between hospital and doctor locations, and EHR systems.
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Many small physician practices have some automated office functions, such as scheduling and billing, but not EHR, said Lorraine Fernandes, vice president and industry ambassador for health care at Initiate Systems Inc., a Chicago-based data interchange software vendor recently acquired by IBM. Physicians, she said, have to decide whether to replace everything or just add new health care technology in the form of EHR.
"They are cautious," Fernandes said. "They're going to make the investment, but they want to make sure they get the return on investment."
Seeking ROI for new health care technology
In addition to software systems, investments by doctors and hospitals typically include tablet computers and laptops that sit on wheeled carts, replacing such old hardware as green-screen terminals. With new equipment comes user training.
At Parkview Adventist Medical Center in Brunswick, Maine, "a lot of nurses didn't know how to use a mouse because they'd been working with green screens," said Bill McQuaid, assistant vice president and CIO.
Catholic Healthcare West (CHW), which provides care at more than 40 hospitals and care centers in California, Arizona and Nevada, is connecting with more than 1,000 clinics and doctors' offices through a seven-year strategy to deploy EHR technology and data interchange systems.
Scott Whyte, CHW's senior director of physician and ambulatory IT strategy, said the foundation is in place for some EHR functions, and the organization next plans to implement computerized physician order entry (CPOE) and nursing documentation for a number of the facilities. "We have a program on the way that is adding those advanced features," he said.
Health IT infrastructure upgrades often necessary
To accommodate the new software systems, CHW will upgrade a lot of infrastructure along the way, Whyte said. Improvements include network and wireless devices, as well as PCs and servers.
Such replacements are common in hospitals and clinics adopting new health care technology. Often there simply isn't enough health IT infrastructure. "Most of the time they don't have what they need, and we're installing a good bit of the infrastructure," said Mike Jones, CEO of ETG, a provider of health care technology and services in Birmingham, Ala.
The services ETG provides to medical organizations range from technology assessment and planning to deployment, remote monitoring and maintenance. The company takes over its clients' technology environments and runs them through cloud-based solutions that cover security, data storage and protection, as well as EHR system maintenance and monitoring.
Looming meaningful use penalties are prompting many organizations to act, and a growing number are looking into a cloud computing-based system because of the low cost of entry. Gorenberg still runs an on-site server for his practice's EHR platform but he's tapping the cloud for practice management software, he said. Instead of deploying the software in every location, his offices need only an Internet browser to access the application.
By going with the Software as a Service approach, Gorenberg's practice avoided the $50,000 up-front costs an on-site system would have incurred, he said. Instead, he pays his technology provider, AdvancedMD Software Inc., monthly fees based on use. About 15 people use the system now, but if that number increases, the fees will go up. If he ever had to reduce his use, fees would be adjusted down.
A big plus is that the AdvancedMD system integrates with Gorenberg's EHR system from EncounterPRO Healthcare Resources Inc. The platform that AdvancedMD replaced never quite integrated fully with the EncounterPRO system.
Failure to communicate hinders adoption of new health care technology
Like Gorenberg's practice, some health care organizations have assembled "best-of-breed" environments that create a hodgepodge of complexity. Others have inched into automation, cobbling together systems that handle single functions, such as billing or e-prescribing. The problem is that the systems often don't communicate, hurting staff productivity and driving up costs.
Lorraine Fernandesvice president, Initiate Systems Inc.
Such was the case at Parkview Adventist until the hospital switched from an amalgamation of applications and operating systems to a Medical Information Technology Inc. platform with a complete hospital information system that includes such functions as billing, pharmacy and lab management and EHR technology.
"It was a nightmare," McQuaid said, referring to the preconversion scenario at Parkview Adventist. It was using software from at least seven vendors, and the applications didn't communicate. Pharmacy staff couldn't look at lab records. One application handled CPOE, while another kept inpatient records. Vendors would get acquired or merge, then stop supporting their applications.
As Gorenberg and McQuaid found, it's not enough simply to move toward automation. It's important to assess your needs, pick the right technology and partner with companies that support it properly.
Figuring out what's needed, of course, is no easy task for an organization. Aside from the choice of management and EHR systems, there are also security considerations. Full automation includes giving doctors remote access to files from their laptops or smartphones so they don't drive back to the office or hospital every time they need to check a patient's records.
In addition, if automation is to reach its full potential, hospital locations need to communicate with each other and with doctors' offices through data interchange systems, which transmit information securely over the Web.
Decisions also have to be made about whether to use tablet computers or laptops that doctors and nurses can wheel from exam rooms to patient rooms. MDG Medical in Aurora, Ohio, for instance, sells and maintains the automated medical carts used at patients' bedsides. There, only the one drawer in the cart that contains the patient's correct prescribed medicine will open. The carts also feed information to EHR systems, said Fran Paez, MDG's vice president of marketing and operations.
Medical technology has reached a high level of sophistication, but putting all the systems together and making sure they all work together require a lot of thought and planning. It's no wonder some organizations hesitate to go full-bore. "My head spins thinking of everything that is in flight, and everything that has to be done," Fernandes said.
But as vexing and painful as automation may be, forgoing new health care technology is more expensive in the long run. "How can you afford not to do this?" McQuaid asked.
Pedro Pereira is a freelance writer in Huntington, N.Y., who has covered the IT industry for almost two decades. Contact him at firstname.lastname@example.org.