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HIT Trends Summary for July 2010

Whirlsandtwirls This is a summary of the HIT Trends Report for June 2010. You can get the current issue here.

E-prescribing. Two surveys re-confirm that while e-prescribing adoption is rapidly increasing, utilization continues to lag, particularly with advanced features. HIMSS released a survey about industry support for a DEA rule of allowing for e-prescribing of controlled substances. In this study, 40% say their organizations use e-prescribing, but half of these report doing so in a limited way. The Center for Study of Health System Change confirms these numbers with their study reporting only half of e-scripts users send them electronically and only a quarter regularly use routing and formulary checking and interaction checking together. Barriers include alert fatigue and suspicions about the accuracy of formularies. There are a number of cross-stakeholder groups working on these utilization issues. They are critical.

EHR. Hospital outreach to affiliated practices is a model that makes a lot of sense now. This month HP announced a comprehensive services offering in this area that competes with similar services from its rival Dell. Services include marketing support to educate community physicians, financing mapped to expected incentives, packaged hardware and implementation services and a menu of solutions from its VAR and ISV channel. I believe that hospital-centric marketing may have also had a role in the acquisition of Picis by Ingenix. Picis automates ICUs, ORs and EDs in hospitals with gives Ingenix some acute care assets to combine with its CareTracker EMR. The ED solution could help with medication reconciliation. The rich clinical data sets are attractive targets for Ingenix analysis. And it’s a strong growth segment.

HITECH. The highlight this month is the final release of the first stage of meaningful use criteria. I continue to believe in the approach and the basic metrics as an insightful building block for the next several years. We are getting a better sense that stage two will focus more on deeper utilization and stage three on additional functions for more collaborative care. While there’s been some pushback from a few sets of stakeholders, I believe the criteria balance support for industry leadership as well as encouragement for innovation.

HIE. Three reports out this month suggest the importance of hospital outreach to community physicians when analyzing the early health information exchange market. Information Week profiled four prominent health system efforts to connect with affiliated practices, each with a different approach. An eHI analysis Report.pdf reveals that out of 234 HIEs surveyed only 7 report being sustainable without other business models in play. And KLAS reports, via Healthcare IT News, that most of the HIEs involve either hospital lab outreach, e.g., Medicity, or same vendor connectivity between hospital and physician practice, e.g., Epic, Cerner, RelayHealth. Hospitals have an array of built in incentives to align with community physicians. One that’s very pressing is the need to control readmissions within 30 days. Physicians can be great partners in that effort.

Care Communications. Kaiser reports that email communications between providers and patients (members send 870,000 emails a month to their providers) improved HEDIS quality measures significantly over those not using email. And a study in Lancet of 24 UK practices demonstrate that patients can self-manage hypertension when given broad discretion. Patients order and administer higher dosage prescriptions according to pre-determined ranges and go for lab tests to titrate safely, without seeing a physician. This care plan outperformed usual care. These two stories combine two essential ingredients for the future of the healthcare system, collaboration between provider and patient and patient engagement and empowerment.

Clinical Analytics. As we accumulate more and more structured clinical data as an industry, analysis tools become more attractive. A HIMSS report argues that it’s an area likely to grow. In fact, IBM announced a $100 million effort to research in this area focused on outcomes- and evidence-based decision support at the point of care. And the feds announced plans to inventory research on the comparative effectiveness of medical interventions, such as, medications, procedures, medical devices, diagnostics, behavioral change, and care system strategies. The insurers acquired much of the analytics technologies a few years ago. New companies are arising with next generation ideas as an expanded market for analysis emerges. Over time, providers will amass the best clinical data in EMRs and will likely leverage that in relationships with insurers and pharma.

The Art of HIT. The art this month is Wall Drawing 1152 (Whirls and Twirls), Sol LeWitt, 2005. LeWitt’s wall art is conceptual. He writes a simple set of rules that others use to install the art for various exhibits (For example in Whirls and Twirls he specified the width of the bands and the prohibition against two segments of the same color touching). Here’s a time-lapse video of the process. So like the LeWitt wall drawing, constructed by teams of artisans working only from specific written narrative instructions from the original artist, we begin constructing the new healthcare system from this month’s final meaningful use rules.

Michael Lake has been a healthcare technology strategist for over 30 years. He is President of Circle Square Inc., a San Francisco-based strategy, business development and market research firm, focused exclusively on the healthcare information technology market. The company works with healthcare, life sciences and technology companies on developing strategies, products and business models for complex multi-stakeholder healthcare environments. He publishes the HIT Trends Report monthly. For more information, please see www.michaellake.com.

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whey protein isolateSharon Simon, MDJonathan HalvorsonJohn Techner, MD Recent comment authors
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Health care information technology is becomes revolution in the health care industry…there are many wonderful instruments are found who helps a lot in hospital operations and management as well..!

Sharon Simon, MD
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Sharon Simon, MD

There was a report on the topic of formulary use and warnings for patients of old age in Archives of Internal Medicine, this week. Nevertheless, I reamin concerned about the the safety of what we are all doing as reported here: http://www.ischool.drexel.edu/faculty/ssilverstein/Internal-FDA-Report-on-Adverse-Events-Involving-Health-Information-IT.pdf
There will be low penetrance of these systems until doctors know they have been tested for safety.

Jonathan Halvorson
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By the way, it wasn’t clear to me that physicians who answered that they didn’t use their eRx systems to check formularies weren’t checking formularies electronically. Most health plans have provider portals that allow for formulary checking, and physician offices use these quite a lot. It wouldn’t surprise me if those plan-provided online tools are more reliable in many cases than formulary lookup functionality on an eRx application. So I’d be wary of over-interpreting lack of formulary use in this survey barring further explanation of how the question was asked.

Jonathan Halvorson
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I hope this becomes a regular series. The problems with eRx are the problems with our fragmented delivery system. Large group practices and especially those that are part of staff model HMOs are doing pretty well on eRx and using the advanced features. Room to grow, but nothing to be concerned about. The usual suspects are having trouble with eRx, and for the usual reasons. Older physicians and those in small and solo practices are the laggards. Older physicians have less incentive to go through the hassle of changing their ways, and they got used to the old ways and… Read more »

John Techner, MD
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John Techner, MD

There are a few problems reported here:
http://huffpostfund.org/stories/2010/08/safety-overshadowed
http://www.huffingtonpost.com/2010/08/04/fda-obama-digital-medical_n_670036.html
The cover up is on. The defects and adverse events have been deliberately hidden…thousands of them.
The best thing that would happen for the future success of HIT, if any, would be the vetting for safety and efficacy required of every other medical device.
Best strategy from this strategist: Do not waste money on devices that slow down your care, disrupt your practice, and endanger patients.