For the last two years I’ve focused my energies as a healthcare administrator on helping to progress the National Health Information Infrastructure (NHII) and have been surprised by the newness of this topic among my peers. I’ve suggested the topic to ACHE for their publications because I’m aware of their key role in professional development opportunities for administrators (especially those in hospitals), The September/October 2005 issue of Healthcare Executive included great HIT articles and this month Frontiers followed with two featured articles and three commentaries on EHRs.
Highlights of this month’s Frontiers include:
Transforming the Health System from the Inside Out, Michael Sachs
Michael has some interesting projections for the future of healthcare to expand our thinking, prompt discussion and stimulate creative thinking (brainstorming). For others, these projections may make appropriate talking points to help you generate interest in your community’s project.
Connecting the Providers in Your Healthcare Community: One Step at a Time, Rosemarie Nelson
Rosemarie considers some of the more practical implications for helping clinicians implement health information technology. She addresses the preparatory steps in describing and achieving consensus on a vision of the EHR and the need to establish expectations and assess the organization’s culture and technology readiness, and provides a sample readiness Self Assessment tool.
Rosemarie views the EHR as a change management process and reinforces the importance of identifying and prioritizing the processes and procedures that account for 80 percent of the daily activity in the medical practice and matching these with the EHRs core system functionality. She also lists some low-cost, easy-to-implement solutions that don’t yet require a change in physician work flow, but do help move the practice toward the EHR.
Commentaries
Dr. Peter Basch is cautious about the vision painted by Michael Sachs and presents some compelling counterpoints. He also addresses some of the cost saving projections and points to a recent study by Robert Miller which concludes that small physician practices can save an average of $32,000 a year per physician with EHR adoption.
Thomas East focuses a little more on the return on investment (ROI) of the various levels of EHR functionality and health information exchange and notes that significant returns will require significant investment. He cautions against simply collecting information in computers and highlights EHRs as a societal issue where we need to find the resources if we wish to benefit from the improvements. He is correct to say that we can find the resources if we really want to do so!
Dr. Blackford Middleton points to the need for a robust EHR with appropriate features and functions and EHR systems that can interface with other systems or readily exchange clinical information with other caregivers providing patient care or services. He, too, addresses the value for stakeholders (ROI) and also addresses obstacles.
Of most interest to administrators, Dr, Middleton also addresses management perspectives on leadership, collaboration and incentives and points to our critical role as leaders and managers in this turbulent time of transformation. He offers the following:
1. Leaders in healthcare organizations today must not only see the potential for information technology in healthcare, they must be willing to go the distance, to sustain their vision and leadership, and to materially support the adoption of IT with sufficient resources.
2. The challenge is not only about individual leadership, but about leaders consciously recognizing the importance of collaboration to achieve the benefits of healthcare information exchange across a region.
3. Management attention is needed to ensure that incentives are aligned to stimulate and support the adoption of healthcare IT and also on less recognizable incentives such as, respect and recognition from clinical peers, impact of healthcare IT on the patient-doctor relationships, and HIT as a core component of their toolset.
To manage in this fundamental change process, healthcare leaders must not only be committed in a meaningful way, they must lobby for key incentives to stimulate adoption, and they must be willing to collaborate with other institutions to achieve efficiencies and potential savings with healthcare IT. This is a challenge that calls for a long view on this journey!
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