Realizing IT's potential

Physician Executive, July-August, 2005 by Claude DeShazo, Ronald Fessenden, Peter Schock

In early 2004, Manhattan Research described the results of a survey of more than 1,200 physicians (1) that revealed the top two emerging trends in health care:

1. Demand for online patient-physician communication

2. Use of secure connectivity and messaging among physicians, labs, hospitals and pharmacies

One of the challenges faced by small and mediumsized practices in meeting these demands is choosing among the various models of connectivity and component function. For the busy physician, simpler is better.

More importantly, an integration strategy such as interfacing an off-the-shelf Web-based EMR with practice management systems and secure physician-to-physician and physician-to-patient messaging services will prove to be better and more economical than non-integrated solutions, expensive retooling or new development efforts that are time intensive and cumbersome.

Before evaluating an integrated IT strategy, there are key questions you should ask:

* Does such a solution actually reduce my workload, increase my efficiency and improve my workflow?

* Are the systems and platforms on which the solution is built reliable? Is the underlying architecture accessible or standards-based?

* What is the cost (in time and dollars) of integration or interfacing between my existing systems and any new strategy adopted? Is integration feasible and practical? What about data conversion strategies and costs?

* Does the solution have capacity for growth and inexpensive expansion?

* Does the system or platform have the capability to communicate with other systems via HL.-7, XML or other open standards?

* Can the solution evolve or will it be outdated in three to five years and need to be replaced?

* Are mandatory maintenance and support costs justified, explicitly stated and affordable?

* Can the system or platform actually decrease my operational overhead?

* Does the system support an option for increased income via payer reimbursement or direct charges to the patient?

* How does the technology impact patients who do not have or do not use computers?

Forging a new design

Our experience in exploring IT and IS adoption with physicians reveals that most respondents request only a few things from information systems before making a final choice among multiple design options. Typically, physicians want:

* IT that's easy to adopt, intuitive to use, and helpful in making daily life and practice better.

* IT must be affordable given the economic realities of today's practice.

* IT must not require expensive upkeep, costly software updates or become outmoded in a few years.

* The system must be able to support office workflow, manage tasks such as prescription refills, make and track appointments, order and track lab, X-ray and other tests.

* A system that communicates with other physicians and specialists, service providers and third-party payers.

* A system that communicates, in a secure environment, with patients, and provide-patient access to medical records, and health care information.

Some forward-thinking physicians also require:

* Technology for office use should actually reduce costs in patient care.

* Technology platforms need the option of being a new source of revenue.

* Privacy and security (HIPAA compliance) should not be burdensome.

* Electronic communication with patients should save time and enhance the physician-patient relationship.

To achieve these goals, an integrated EHR that includes a Web-based platform linking online communities including physicians, hospitals, medical services providers, payers, and patients becomes the foundation for connectivity and communication.

Each component of this simple model must be interfaced or integrated with the other components. Each component stands alone yet is interdependent for the model to function successfully.

For the foreseeable future, data necessary for comprehensive medical health care delivery resides in different systems. Shared or common data depends on the use of open standards, Web services, and widely available tools, platforms and software.

The open EHR

The EHR described in this model must integrate with the demographic and billing data contained in the physician's practice management system. Scheduling must interface with a patient-accessible online appointment request system.

Medical records that are electronically entered as the patient completes an encounter must automatically drive the coding and charge capture process. This in turn produces electronic claims that are submitted without the need for labor-intensive data entry.

The tablet computer or similar device becomes the physician's vade mecum. Data entry for the practitioner is accomplished using the touch pad tablet and wireless handheld devices via a combination of voice-activated dictation, voice and keystroke macros, and practice specific templates.

Physicians have access to patient data not just in the office but at home or anywhere they travel. There is no need to rely upon access to paper records. Complete electronic files can be shared among the online community with the click of a mouse. Automated fax servers can support those not connected.