Aiming for more than a base HIT: HHS has declared that we are starting the decade of health information technology . A national health information infrastructure is envisioned, and momentum is growing for electronic health records

Healthcare Financial Management, Nov, 2004 by Margret Amatayakul, Steven S. Lazarus

AT A GLANCE

To position themselves for optimal use of health information technology through goals such as electronic health records and the eventual transition to a national health information infrastructure, providers need to make better decisions regarding the use of their existing systems.

The fact remains, however, that most healthcare organizations have an existing information infrastructure that does not currently support such a vision. Information silos still exist and operational savings are not being realized. Vendor offerings for clinical data repositories (CDRs), computerized provider order entry (CPOE), EHRs, and other advanced functionality are simply not up to par with new expectations. What's more, most providers do not have the funds necessary to replace their existing legacy systems with all new technology.

Yet these challenges needn't cause providers to simply throw up their hands. While the industry readies itself for tomorrow's prospects, efforts still need to be made today to add incremental value to existing information systems. To best position your organization for the future, you will need to get the most out of what exists today. determine future needs, and plan appropriately for new components.

Using What You Have

There are several ways to improve utilization of today's information systems.

Use all existing functionality. In many cases, systems are underutilized. Functions have not been turned on--sometimes for reasons as simple as they didn't represent immediate needs or because no one bothered to explore their potential. These untapped functions may improve productivity.

Enforce policy. Running parallel systems is costly, and duplicate efforts often raise the potential for errors that can affect patient safety. As an example, providers that use laboratory information systems to provide results online should not need to then print and file the laboratory results as well. When a large proportion of clinicians prefer to access results online, it is too costly--and a risk to patient safety--to eater to the few who do not. Policies regarding adoption of electronic medication administration records and CPOE carry similar importance.

Redesign work flows. Providers can often achieve significant operational savings by structuring workflows to follow the design of the information systems. These workflows may be different than manual practices, but often are designed to take advantage of the technology to produce savings or improve safety. For example, carrying around a device to scan patient wristbands and medications introduces several process and workflow changes for nursing staff (how to inform patients of the process, where to put the device while administering the medications, etc.).

Determining Future Needs

Many providers make the assumption that they can't afford an EHR, are not ready for provider/patient portals, or wouldn't dream of providing system access to payers. Others have investigated vendor offerings and find them lacking. As a result, current systems stagnate, or the healthcare organization adopts bridge technology that detracts from pushing the envelope further.

Some of this problem can be attributed to the law of supply and demand. Purchasers haven't demanded new and better functionality. Vendors haven't supplied new and better functionality because there was no demand. Now with the push to adopt HIT, few are ready.

To pave the way toward tomorrow's functionality, providers should take the following actions.

Adopt badge technology cautiously. Document imaging systems, speech technology, and clinical messaging systems may seem like ways to go if more comprehensive technology is not available or too expensive. However, these options may add only relatively small incremental value with respect to access to information while perpetuating the current paper-based environment. As such, they should be considered complementary or adjunct technology, rather than substitutes for a more complete solution.

Define a migration path. Even if you know the vendor doesn't have the systems you desire yet or you don't have the financial resources, it is still important to develop a migration path toward an end goal. A migration path can help you recognize that there are workflow and process improvements that must come before technology is applied. A migration path can also help you make demands on your vendor for incremental improvements in existing systems to ultimately support the broader end goal.

Planning for New Components

Providers also need to begin planning today for tomorrow's HIT, particularly in regard to use of data standards. In implementing today's systems to save time and money, providers often have used translators and interfaces to convert data definitions and formats to make their legacy applications interoperable with new applications. HIPAA transactions are a prime example. Instead of truly adopting the X12N code sets, many providers have turned to an EDI translator or used a clearinghouse that mapped the old data to the new. Although such translations work for the most part, some transactions still need to be reworked because of data quality issues.