Tim J. Edwards

Healthcare IT, Process Improvement, Making IT Easier

Tim J. Edwards - Healthcare IT, Process Improvement, Making IT Easier

HIMSS09 Monday Wrap Up

HIMSS09 Banner

Welcome the second full day of HIMSS09. After yesterday’s marathon sessions and opening reception, I was a little slower in getting out of bed this morning, but still made it in time to hear George Halvorson’s keynote address. Of course, it was a two coffee morning.

The keynote started with a video of people on the streets of Chicago discussing their feelings on medical records and the access that is available for their own records. The responses ranged from hilarious to disturbing; here are two of my favorite lines:

  • I’m a physician in my 50s and my goal is to make it out of practice before being required to implement an EMR. EMRs cause 4-5 months of financial turmoil and they have not shown any ROI.
  • I live in a small town and they know everything about me. My medical records are available behind the desk in my doctor’s office. If I needed my records, I could just go there and grab them.

I guess we still have a long way to go.

Liz Johnson, HIMSS Vice Chair started things off with a couple of administrative tasks and a quick overview of yesterday. She then discussed the financial report for HIMSS that basically closed before the economy went south. Operating revenue increased by 7% over the past fiscal year and HIMSS is financially sound and poised to lead HIT now and in the future. That was good to hear and judging by the attendance this year, next year’s report will likely be similar.

George Halvorson, Chairman and Chief Executive Officer of Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, did a great job in setting the stage by outlining some of the most interesting issues facing HIT today. A couple of interesting quotes/facts from his talk:

  • The business model of care is based on maximizing the number of things that have fees. We have 18,000 billing codes for procedures and not one billing code for a cure. No billing codes for improved health.
  • A Rand study found caregivers got care right only 50% of the time for adults and less than 50% for kids.
  • How often doe diabetics get the right care? According to Rand, 8%. If we could move that to 80%, it would cut the number of kidney failures in this country in half.
  • He sits on the board of the IOM and their goal is to see 90% of care based on scientific evidence by 2020. In what other industry would we set the bar so low?
  • You’ve seen the commercials for new Alzheimer’s drugs and the warning to inform your physician if you are taking various medications before starting on their drug. How pathetically sad it is when we ask Alzheimer’s patients to inform their doctors of the drugs they are taking?

Kaiser seems to be ahead of the curve in their HIT implementation and I would have liked to have another 30 minutes of his talk. I am planning to pick-up his new book, Health Care Will Not Reform Itself. The proceeds from his book are going to a medical charity in Oakland.

HIMSS09 Conference Floor

Session: The Intersection of Healthcare Reform and Health IT

This session featured Georgia Congressman and physician Phil Gingrey and former Wyoming Governor Jim Geringer. Both men have a history and strong interest in healthcare and after some opening statements, got down to some serious Q&A.

The session opened with discussion of healthcare reform and HIT reform and how the two are required to make any serious change. “If we automate a bad system, all we will have is a really fast, bad system.” Both men seemed to be advocates for wellness and looking beyond episodic care to public health. “Prevention is the key to moving forward; prevention of illness and prevention of bad health.”

One of the most compelling questions came from an individual who outlined how federal regulations (Red Flag Rules, Stark, HIPAA, FDA Regulations, etc.) are putting a squeeze on smaller hospitals and making it harder to keep the doors open. Governor Geringer had the most interesting response, he said, “Your first obligation is to tell somone. The world is run by those who show-up.” While at first I was put off by the answer, the more I thought about it, the more I like it. He encouraged using the Obama Administration’s emphasis on transparency and accountability as a reason to expose just exactly what the federal government is doing to squeeze healthcare providers. Governor Geringer’s quote, “The government’s roll is to recognize when to get out of the way.”

In the end, both men were clearly on the side of fully integrated EMRs which brought another interesting question. Apparently, many supporters of a Michigan RIO have pulled out of the effort to develop their own EMRs and earn their slice of the stimulus package HIT pie. What can be done to address those who were working together and now are off on their own? Neither had a great answer to the question and sited the need for cooperation and interoperability, but missed the general point. Is the ARRA actually being somewhat counter-productive in regard to HIT? We will see.

As for not answering questions, Congressman Gingry had some great comments:

  • If I were doing this and it was within my power, I think the adoption of a fully integrated ERM would be goal number 1.
  • Patients don ‘t wan t the government standing in the exam room between them and their provider.
  • I’m not sure if that answered your question, but I’ve learn politically if you don’t like the question, answer another one.

And that brought me to a big two hour, visit your favorite vendor break. I recognize why HIMSS wants this break, but I don’t particularity like it. The good news is, I had time to write the first half of this post and catch-up on some communication. Suggestion for next year’s HIMSS, more Recharging Stations!

Session: Using an EMR to Find a Needle in the Haystack: The Next Generation of Clinical Decision Support

The session was conducted by Dr. Robin Helm and  their EMR ManagerSandra Olsen who work for St. Joseph Family Medicine Residency in Northeast Wisconsin. They went live with their EMR in 2001 and completed,  feature build-out in 2004, and now are looking into ways to leverage the data that is now available in the system. “The EMR was not important unless we cold improve patient care.”

So, to improve patient care, they started by developing  a quality improvement model

  • establish benchmarks
  • select champions (utilizing both nursing and physicians is a key)
  • set goals based on benchmarks
  • write reports
  • provide education to provider or patient
  • create interactive programs
  • apply to other disease populations

They have used this model to improve immunization rates, improve the quality of diabetes care, extend screening for led-related health issues, and many other issues. A side benefit to their system is the availability of quality metrics that can be leveraged on multiple improvement efforts and are used to benchmark physicians against their peers; blinded of course.

My sense of their system is, it is relatively basic, but quite effective. You don’t have to have the most impressive system to improve clinical quality; you just need the data in a structured and meaningful way.

Session: From Kiosks to Web: Self-service Opportunities in Healthcare

The presentation was conducted by Jeff Nieman and Ron Kelley Conifer Revenue Cycle Solutions (an off-shoot of Tenet Healthcare).

This session was one of those moments when your realize that there are people who “get it” out there. Conifer has produced kiosks for online bill payment and patient sign-in that are incredibly successful and producing real cost-savings while improving accuracy. The basic premise is, we want to have self-service and if it’s done right, it will make a big difference.

“Self service is doing exactly what you done before in a self service way.” You don’t need to create a new process for self-service, just do what you do.

In 2008, the first year of the system, they had the following results

  • 19,821 patients used the self-service kiosks
  • 97.3% of patients successfully signed-in
  • 84% of patients did not want a printed paper copy of their forms
  • on average, patients took 2.6 minutes to check-in
  • 98% of patients were satisfied with the tool
  • 48% of users were 55 or older
  • 33% corrected their records, improving accuracy of their data

Those are solid numbers and really point to what is going on in the world today. We want automation and self-service. Go to a supermarket, the airport, a Home Depot, they all have kiosks and everyone from kids to seniors are using them. They save time, save paper, and improve accuracy.

Great quote, “If you are not online and paperless, you are missing a huge opportunity for cost savings.” Their ROI model is based on a cost of $.25 per printed page and with the reduction in paper of 80%, they are saving over $5 million annually. That’s a lot of green.

Next up, the HIMSS09 Tweetup. Looking forward to meeting all the tweeps running around here.

HIMSS09 Tweetup

The first annual (I hope) HIMSS Tweetup was a smashing success. I enjoyed meeting as many of the HIT tweeple as I could and hope to stay in touch when we get back to the real world. Kudos to Cesar (@himss) for pulling this together!

This is a very long post and if you didn’t make it to the end, I completely understand. If you did, please share your thoughts on the HIMSS09 conference.

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