Becker's Hospital Review

35 Health IT A s the saying goes, time is money — and the healthcare industry has invested a lot of both. These investments run the gamut of the industry, but special focus and consideration can be given to the IT sector of healthcare. By way of the Health Information Technology for Economic and Clini- cal Health Act alone, signed into law by President Obama in 2009, the federal government has in- vested approximately $26 billion in health IT. But the implementation of IT systems, including EHRs, health information exchanges, electronic prescribing and telemedicine to name a few, hasn't been all smooth sailing. The administrative burden has led some to question the value of IT compared to the time and energy spent on it. It also provides a retrospective look for the healthcare industry to see past mistakes and learn from them. Is it worth it? Much of the dialogue surrounding health IT in- novation and investments is laced with comments of wastefulness, a big brother type of approach or a hurried implementation leaving many ill- equipped to make good on the investment. These questions and concerns aren't unfounded — $26 billion is a large chunk of change, and many in the industry are left feeling more frus- trated than accomplished. But many industry experts, technology consul- tants and CIOs themselves seem to agree that in- vestments made aren't investments wasted. "I'd never say health IT is not worth the invest- ment," says Fletcher Lance, managing director and national healthcare leader at North Highland, a global consulting group. "I'd see it more as a ver- sion one. Version one is always bumpy." If there is a version one, then there are versions to follow that will improve upon lessons learned by ghosts of IT projects past. Lesson one: Too much too fast is no good The end of 2014 meant the beginning of Medicare payment adjustments for eligible hospitals and professionals who failed to meet meaningful use requirements — approximately 200 hospitals and 257,000 professionals in all. Upon hearing the numbers, the American Medical Association released a statement saying it was "ap- palled" that more than half of eligible professionals would face penalties for failing to meet meaningful use, a number it says is worse than anticipated. "The strict set of one-size-fits-all requirements is failing physicians and their patients," the AMA's statement read. "They are hindering participation in the program, forcing physicians to purchase expensive EHRs with poor usability that disrupts workflow, creates significant frustrations and in- terferes with patient care and imposes an admin- istrative burden." The AMA's condemnation of meaningful use pen- alties reflects other complaints about meaningful use policies and guidelines that have been voiced over the years. In sum, hospitals, health systems and clinicians were trying to adhere to a set of guidelines that required significant culture and workflow changes and were only given a minimal amount of time to meet them. In an April 2011 piece in Becker's Hospital Review, Michael Sinno, former vice president and CIO of Cooper University Hospital in Camden, N.J., and Snehal Gandhi, MD, director of medical informat- ics at Cooper University Hospital, said the time- frame to implement new information systems is generally much longer than the timeline meaning- ful use requirements offered hospitals and health systems. And with meaningful use's constantly changing deadlines, it can be difficult to keep track of what needs to be submitted at what time. Attestation deadline dates have been changed and the time pe- riods to demonstrate meaningful use have changed. In the fall of 2014 alone, CMS changed the deadline for meaningful use attestation three times, first to Oct. 1, then to Nov. 30 and finally to Dec. 31. "It's unfortunate that a substantial amount of the IT resources are being consumed responding to government regulations," says Wayne Sensor, CEO of Omaha-based care coordination solu- tions provider Ensocare. "Meaningful use has distracted the industry from focusing on IT solu- tions that drive substantial value in the form of more efficient, high-quality healthcare." This isn't to say that meaningful use is a bad in- centive. The ideals and goals of improved clinical quality, patient safety and clinical outcomes on the individual level and population health level should be heralded. But the timeline left some hospitals and health systems scrambling to pur- chase, implement, adopt and integrate brand new systems into their workflow. Mr. Lance illustrates this issue in the context of the patient portal. "With meaningful use, there's the requirement to implement [the patient portal], but are they really providing the value that the patient wants? What we're doing right now is we're just putting up the portal to meet the requirement, and that's not going to work out really well." Instead, something more than a financial incen- tive needs to be driving healthcare organizations to adopt these tools. And they need adequate time to do it. Lesson two: Be wary of so- called 'silver bullets' Interoperability is a healthcare buzzword today. Those in IT want systems to "talk" to one another, and clinicians want a way to access information wherever and whenever they need to do so. Enter health information exchanges; the theoreti- cally perfect solution to the interoperability prob- lem. But as it goes, HIEs also have their flaws. For one example, take Owensboro (Ky.) Health, a 477-bed hospital in the northwestern corner of the state. Owensboro Health participates in the state of Kentucky's HIE, aptly named Kentucky Health Information Exchange. Michael Elley, CIO of Owensboro Health, says his experience with KHIE has demonstrated both positive and negative effects. The hospital's par- ticipation in the HIE has helped it meet mean- ingful use requirements, but given its location on the state border, Owensboro Health is unable to communicate with many surrounding locations. "We're on the border of Kentucky and Indiana, and there's at least two health systems that are 45 minutes away from us, and they're not on the state HIE," he says. "A lot of these exchanges, if they're a state HIE, they are not crossing the state borders. And then if not every facility and provider is a part of that, you're still [left] with an incomplete pic- ture, and the value you're going to get is lessened." But HIEs don't have to be the only path to in- teroperability. Mr. Sensor suggests the industry shift its attention elsewhere. "I am a complete supporter of interoperabil- ity, and I think we owe it to our patients to find mechanisms to assure that their clinical informa- tion can follow them. However, I'm not person- ally convinced HIEs are the solution," he says. While many HIEs have succeeded, many have also failed, Mr. Sensor says. There's another caveat: The industry doesn't necessarily agree on what success for an HIE really looks like, which makes measuring results and outcomes difficult. Additionally, maintaining HIEs are costly, and stakeholders aren't jumping to volunteer the dol- lars to fund these systems that have not fully dem- onstrated their benefits. "You could make an easy case that this is valu- able to the patient, but no one expects the patient to pay for their data to move from Hospital A to Hospital B," Mr. Sensor says. "Likewise, many would suggest that independent physicians would generate some value out of the existence of infor- mation flowing between providers, and again, I think it would be unrealistic for independent phy- sicians to finance or pay for a portion of HIEs." Waiting on the ROI: 3 Lessons From Health IT Investments By Akanksha Jayanthi

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