ONC12: Patient centeredness is 'tangible, achievable'

“Innovation is critical to every goal we have as a nation,” said Todd Park, U.S. chief technology officer, “and nowhere is it more important than in healthcare.” Park led a panel discussion on health information exchange and interoperability at the Dec. 12 annual meeting of the Office of the National Coordinator of Health IT.

Dean Health System is a present-day accountable care organization, said Craig E. Samitt, MD, MBA, CEO of the Madison, Wis.-based organization, whom Park described as “a paragon of awesomeness.”

Samitt said, “We survived the disintegration of integrated health systems. I can’t underscore enough the importance of technology and how that has been transformative for us.” However, organizations cannot step incrementally into EHR adoption and get to optimal use. “In the world of value, you can’t just use IT piecemeal. You need to use the most capability of technology.”

Dean’s objective is to “prove to the country that we can be the best in the nation in clinical quality while being the best in the region, if not the nation, for patient satisfaction.” The organization currently has one of the lowest per member per month costs. An additional objective is engaging and satisfying the workforce. Making progress in all four of those objectives underscores the importance of technology. Samitt said that when he was in business school and instructors discussed case studies of the best companies in the world, he found it remarkable that not one healthcare company was included. “As an industry, we have not used all of the necessary strategies to be transformative, like technology and use of data.”

“We’re at a time in healthcare where we are moving from fee for service to, ultimately, fee for outcome,” said Scott Whyte, VP of IT connectivity for Dignity Health, which primarily serves California, Arizona and Nevada. “We are concerned about the health of our communities. Many have poor and underserved folks. We see collaboration as absolutely critical at this juncture in healthcare and IT is absolutely essential to quality measurement and to collaboration.” Whyte said health IT is not Dignity’s number one priority but certainly is a critical means of achieving its goals.

AARP was originally formed to increase access to quality, affordable healthcare for retired teachers so “healthcare is in our DNA,” said Bill Walsh, senior strategic advisor of the advocacy organization. “Early on, we recognized the power of health information exchange to improve quality outcomes and care coordination and track racial disparities.” The organization is trying to protect Medicare and Social Security right now, said Walsh, but “our second highest priority is implementation of the Affordable Care Act.” Each AARP state office is charged with overseeing implementation from the consumer point of view.

The group also has launched its own personal health record and has a media blitz planned for 2013. “We see health IT as central to our mission,” Walsh said. He said user testing of AARP’s PHR indicated positive feedback. However, the users didn’t like that it is only available online. “That’s a real obstacle. We have to negotiate that.” Meanwhile, 75 percent of people surveyed were somewhat or very concerned about a data breach if their data is online. That’s a real concern, Walsh acknowledged, but privacy concerns “mask different obstacles of awareness. Our members don’t understand the value of the PHR and information sharing.” To that end, the AARP is launching a multi-faceted campaign they hope will give people more confidence in the system.

David Lansky is CEO of Pacific Business Group on Health, which works with large companies with hundreds of thousands of employees. Those companies have a common concern about healthcare and work together to try to drive improvements. Lansky noted a paradox among most companies—they don’t want to think about IT very much, but it is foundational to their goals. “Delivery of healthcare is not part of their day-to-day business, but it is chewing up enormous amounts of their bottom line and exposing employees to both benefit and risk.” About one-third of compensation goes to healthcare and that figure is growing by 6 to 10 percent a year. “It’s not clear what they’re getting back for that expenditure.”

Technology has been a means to an end, said Samitt. “You can’t manage what you don’t measure and you can’t measure without technology. For us, the end game is developing the analytics. We rely heavily on external benchmarking.” Dean started with external validation and the next step is reporting. The organization is now profiling–-gathering data with the purpose of analyzing internal performance.

Meaningful Use has served as a catalyst to develop a safer system that improves care, said Whyte. “The term resonates with non-IT leaders. They want to see outcomes not acronyms.” Dignity’s physicians are live on a very comprehensive ambulatory EHR and 31 hospitals are part of a health information exchange. “We’re working on a patient portal and working on addressing how we can better engage with our patients and make this really simple.”

The healthcare industry is “baffled and frustrated to look at their own industry,” said Lansky. “They can’t believe that this incredibly expensive industry hasn’t already adopted” IT more thoroughly. Meaningful Use Stage 3 begins to “put that out there. Quality measures are going to drag us all kicking and screaming into that world.”

Health IT will result in much more personalized medicine, he added. “We tried to create one-size-fits-all medicine because we had to. Care has been very focused on a care management protocol. At the end of the day, the benefit to the patient of the transformation toward value is we will improve quality of care, improve the service, lower the cost and reduce waste, and do that in a manner that specifically addresses their individual needs. Patient centeredness is very tangible and very achievable.”