October 21, 2014

Dr. House, EHR and Consulting: The Case of the Unpopular Mandate

EHR, HIPAA, HITECH and its Impact on Successful Implementations

Consulting and the Fictional TV Doctor.

At a high level, information technology professionals are like physicians.  They recommend new treatments (EHR software) to address conditions (HIPAA).  Unfortunately IT pros don’t get paid nearly as well, but at least we both worry about outsourcing to some degree.

The stereotype of the IT professional can also be compared to a doctor, or at least a fictional one, Dr. Gregory House.  Sullen, anti-social, with a high regard for his own knowledge, Dr. House avoids all contact with his customers (patients).  He only swoops in to provide a solution to a problem (condition) before he retreats once more to his solitude.

On that note, let us review one of the primary “conditions” facing Healthcare IT professionals today, Electronic Health or Medical Records.  Of course there are underlying issues that affect this condition as well, such as HIPPA, HITECH, MMA and AHCAA.

Electronic Health Records (EHR) has been a source of controversy since President Bush signed an Executive Order (13335) back on April 27th 2004.  The EO pushed the concept of full EHR implementation for all Americans by 2014.

However, this EO didn’t appear in a vacuum.  Over time, like barnacles on the hull of a boat, mandates have accumulated on the original legislation that started it all, the Health Information Portability and Accountability Act (HIPAA).  This lengthy list of guidelines and regulatory policy was passed nearly a decade before in 1996.

Prior to the 2004 order, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) was passed in 2003.  This did not specifically mandate any technological solutions, but it did effect health care providers Medicare compensation and changed the regulatory landscape.  This combined with HIPAA already set the table for push back amongst the health care community.

With the advent of EO 13335; basically a technological solution pushed on unsuspecting customers, it was received poorly or was ignored.

In 2009, as part of the American Recovery and Reinvestment Act the Health Information Technology for Economic and Clinical Health Act (HITECH) was born.  Basically HITRUST adds teeth to HIPAA mandates on the treatment of Patient Health Information (PHI) and the steps an organization must follow after a patient data breach, including EHR systems.

Well, things seem to not have changed since 2004.  EHR is still unpopular, expensive and with the latest research in hand, doesn’t seem to improve productivity or patient care quality.  This seems to be true even if you tack on expensive Clinical Decision Support (CDS) systems.

The pieces to the EHR / EMR Puzzle

Well, This Looks Easy to Understand & User Friendly!

Let’s look at the popularity quotient. Based on survey developed by HCPlexus only 39 percent of the 2,958 physicians polled believed that EHR will have a positive impact on patient care. The remaining 61 percent remained skeptical to the value of this technological push.  24 of the 61 percent believed EHR would be detrimental to patient care.

The HCPlexus survey holds some other great data; such as how 65 percent of physicians believe that the quality of care will decline over the next five years.  Another interesting data point is 57 percent of doctors believe that the Affordable Health Care for America Act (AHCAA) will negatively affect patients.  Even more uplifting is how 78 percent believe that the AHCAA will negatively impact the physician profession in general.  Which is probably not a good trend considering the U.S. will be short of 150,000 doctors over the next fifteen years.

While it could be easy to dismiss these results as physicians acting as curmudgeons or Luddites there is data to back up their recalcitrance.

According to a study published in the American Medical Association’s (AMA) Archive of Internal Medicine, only 1 in 20 “Quality Indicators” showed any measureable improvement with EHR and CDS used in patient visits.

The study, Electronic Health Records and Clinical Decision Support breaks down the data provided by the 2005-2007 National Hospital/Ambulatory Medical Care Survey.  Basically 255,402 ambulatory patient office visits were tracked and neither standalone EHR or EHR with CDS showed any significant increase in patient care quality.

So after all of this exposition, how does it apply to the information technology consulting profession?  As I have mentioned before, IT pros are going to need a deep understanding of the business they are supporting.

For example, if you are working at a Healthcare client and are in charge of the EHR project, you may want to know that more than half of doctors hate the EHR concept and the reasons behind that animus.  You may also want to be aware of research that shows EHRs in an unflattering light on productivity and patient care.  Because we have all sat through sales pitches where the EHR vendor representative has waxed poetic on the many virtues of their system; which always include productivity and patient care benefits.

How it professionals should interact with their clients.

Collaborative Problem Solving

After all that has been covered, how does this relate to a fictional TV doctor?  Well, I’m not advocating you use a cane, insult people and dabble in prescription drugs, but to think outside your specialty.

One of the main reasons Dr. House is sought out is his uncanny ability to look for the unique circumstances that could be causing a patient to be ill.  Generally his peers miss the telltale signs of a disease because it is outside of their area of expertise.  Dr. House just has a tremendous well of knowledge to draw from, which comes from a wide variety of sources.

You will immensely add to your value as a professional if you make the business of your customer your business.  To understand how they generate a profit, who are their customers, how they market products and services, etc.  This will give you that rare insight that will enable you to provide some fantastic solutions to your clients.

Just don’t be sullen with your customers and whack them with a cane.

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