INFORMATION TECHNOLOGY

By Kathy Dix

Information technology (IT) is a small phrase encompassing a big concept — IT has taken over our lives, in the form of mobile phones, Blackberries, iPods, and other mobile data. It is a matter of convenience in our personal lives, but essential in today’s healthcare environment. Electronic medical records (EMRs) are just one piece of the puzzle, appearing in ambulatory surgery centers (ASCs) alongside picture archiving and communications systems (PACS), updated imaging technology, and telemedicine, allowing physicians to view X-rays, patient files, and endoscopic images a world away.

IT has become essential not only to save time, but to increase efficiency in the workplace, enhance patient safety, and lower costs. Although technology may appear costly at the front end, the return on investment can be rapid.

Physicians and other healthcare professionals are notorious for being resistant to change — a trait that has an obvious and dramatic effect on how easily and quickly new technology is implemented in a surgery center.

In July 2006, the first round of ambulatory electronic health record products were certified by the Certification Commission for Healthcare Information Technology (CCHIT). The Department of Health and Human Services (HHS) awarded CCHIT a contract in the fall of 2005 to develop certification criteria and a certification process.

“This seal of certification removes a significant barrier to widespread adoption of electronic health records. It gives healthcare providers peace of mind to know they are purchasing a product that is functional and interoperable, and will bring higher-quality, safer care to patients,” Leavitt said, in a press release. CCHIT certification indicates that EHR products meet baseline levels of functionality, interoperability and security in compliance with CCHIT’s published criteria. This impartial seal of approval paves the way for adoption of health IT products by limiting the risk associated with investing in health IT.

The CCHIT is certifying health IT products in three initial phases:

First, outpatient or ambulatory EHRs 
Second, inpatient or hospital EHRs 
Third, architectures or systems that enable the exchange of information between and among healthcare providers and institutions.

Additionally, Leavitt noted that HHS will soon publish rules creating anti-kickback statute safe harbors and physician self-referral law exceptions. These changes will allow certain donations of health IT that may not have been permitted before, allowing hospitals and other healthcare providers and suppliers to take a more active role in contributing to health IT adoption.¹

“The most visible IT issue in the outpatient market today centers around the push towards the digitizing of health records,” says Craig Veach, senior vice president of operations with Amkai™ Inc. “Corporations like IBM want to provide a patient-controlled electronic record. Intel, Wal-Mart, Pitney Bowes and others recently announced that they want to develop a system that will access insurers’ records, pharmacy records and other healthcare organizations, to provide an electronic record for their employees. The scope of these projects may be their downfall. One large organization, Kaiser Permanente, is experiencing significant ‘challenges’ in establishing their own electronic record system.”

The conventional wisdom is that EMRs will be a fact of life in healthcare within the next 10 years — some say even sooner, he adds. “How that occurs is still to be decided. However, if you look at history, you may gain an edge on the process. The introduction of IT to healthcare in the early and mid-1980s is not dissimilar to our current position. Large organizations were the only ones that implemented early IT solutions to assist with the cumbersome healthcare reimbursement process. Technology changed all that with the IBM personal computer (PC). Many IT companies sprang up almost overnight to supply software for the outpatient market. In the mid- to late 1990s, a wave of consolidation reduced the number of vendors and improved the quality of the systems due to competition. Even with the consolidation, there are still hundreds of vendors and systems available today, and more are being developed.

“Why didn’t the entire market shrink to just one system? Simple — you cannot maintain a system to meet every single need that the thousands of healthcare organizations required. I believe the same will happen with the EMR initiative. Just like the administrative systems of the late 1990s developed the processes to communicate and exchange information, so will the electronic medical record systems,” Veach concludes.

A recent survey indicates that Americans want electronic personal health information to improve their own healthcare, because they believe that the online services enabled by such access is likely to increase their quality of care. Additionally, the public sees online records as a way to increase healthcare efficiency by reducing unnecessary and repeated tests and procedures. But they also see this as a way to exert more control over their own healthcare.

However, there is still concern over the potential for identity theft and privacy risks. The general public believes that there is a role for government to play in ensuring the security of electronic personal health information.

Lake Research Partners (LRP) and American Viewpoint conducted a survey among 1,003 Americans nationwide in November 2006 for the Markle Foundation.

While younger Americans are most likely to express interest, more than half of those 60 and older (53 percent) are interested in accessing their health information online.

And the public supports the use of their electronic personal health information for purposes other than their treatment, with appropriate safeguards. A majority of Americans would be willing to share their information (with their identity protected) for a number of uses, including sharing information with public health officials to detect disease outbreaks or bio-terrorist attacks, with researchers, doctors, and hospitals to learn how to improve quality of care, and with appropriate officials to detect medical fraud.

“Any system that improves efficiency is going to assist today’s healthcare organizations,” Veach points out. “Many new systems offer automated tasking to make people more effective by reminding them of work that needs to be done. Improved electronic communications can elevate efficiency. However, most of the improvements in current workflow contribute marginally to the bottom line when compared to the benefits delivered by true EMR systems.”

EMRs can deliver more benefits than the others combined, Veach asserts. “Reduced cost for storage, staff time spent looking for missing records, filing and pulling records, not to mention improved patient safety, are direct results of an EMR that impact the bottom line. Even more efficient is implementing a system based on single foundation software (SFS) that presents a common user interface and shares data rather than passing information back and forth between two different systems,” he adds.

There are many other areas of improvement in healthcare besides the EMR, one of which is the software accelerator. Catalis Inc. offers a graphical health records (GHR) software accelerator. “This is a sea-change advancement in health information technologies,” says Catalis president and CEO, Randolph Lipscher, MD, MBA.

Instead of being built on a desktop PC platform and retrofitted into a tablet PC or simply remaining on a PC anchored to a desk, the Accelerator is specifically designed for the tablet PC. The system requires no typing, and uses patent-pending graphical input devices to expedite information flow from doctors into computers.

It is designed to replace the traditional medical clipboard with a tablet PC that connects doctors to every aspect of the healthcare industry. It connects the patient management system, the doctor, the office front desk, the nurse, the labs, the pharmacy, the radiology department and patient billing in one comprehensive system. Health professionals can hand-write their diagnoses and order lab tests, prescriptions and follow-up visits instantaneously.

Another issue — perhaps not at the forefront but important nonetheless, is improving surgical efficiency and turnover times to improve the bottom line. Ensuring that all instruments in a set are properly processed at the start of a surgical case continues to be a challenge, but there is now an IT solution for this as well. Integrated Medical Systems International, Inc. (IMS) offers a platform that focuses on instrument readiness. “The new instrumentReady platform means IMS works with healthcare facilities to ensure that instruments are ready when the surgical team is ready,” says Gene Robinson, CEO for IMS.

The lack of available and functional instruments can affect patient safety and increase the stress level of surgical nurses and staff. Not having instruments ready reduces the number of surgeries able to be performed on a daily basis, and therefore, decreases revenue and profitability.

There is also an enormous opportunity for the outpatient marketplace to save time and money by implementing an imaging and printing infrastructure. Hewlett-Packard has offerings designed to reduce costs and optimize the printing environment in healthcare. The Managed Imaging and Printing Services and Total Print Management solutions can provide an easy way to standardize and manage costs above and beyond hardware to help ASCs and surgical hospitals to achieve cost savings, improve efficiencies, generate positive operation results and minimize risk.

Security is a major concern for the company’s healthcare clients, so Hewlett-Packard partner Capella Technologies offers a job accounting and security solutions to protect the privacy of patients. There is even an option that requires an individual’s thumb scan in order to print.

Guided patient registration is also a newer innovation for improving efficiency in the front office. As it provides prompts to assist registrars in selecting from valid options, guided registration can populate the patient’s record with the correct insurance data, resulting in enhanced accuracy and efficiency. This type of technology, such as Cincom’s Intelligent Guided Registration™, sits on top of a hospital’s existing health information system.

Radiotherapy treatments have also been revolutionized. Toronto Sunnybrook Regional Cancer Centre (TSRCC) purchased two Elekta Synergy ® systems and was one of the first centers in North America to install MOSAIQ™ Oncology PACS from IMPAC Medical Systems, Inc., an Elekta company. Synergy is an image-guided radiation therapy (IGRT) solution, revolutionizing radiotherapy by offering integrated 3-D volumetric imaging at the time of treatment. Imaging patients in the treatment position during the actual time of treatment can offer significantly greater treatment accuracy and higher confidence that the intended therapeutic dose is delivered to the patient as planned.

IMPAC’s information technology solutions optimize radiation oncology workflow and support retrieval and management of data stored by other hospital departments as needed for IGRT. While general radiology PACS are not designed to tightly integrate with Electronic Medical Records (EMRs), MOSAIQ Oncology PACS is connected through the foundation of MOSAIQ EMR, maintaining consistent, comprehensive access to patient delivery and imaging data for oncologists. This allows physicians to see images along with treatment histories, protocol notes, treatment set-up parameters, quantitative image guidance results and other information in DICOM, DICOM RT and non-DICOM formats.

Then there are the broader solutions, those that encompass multiple divisions of the surgery center. Siemens Medical Solutions IT division offers Soarian®, a healthcare information system with a workflow engine that integrates IT, modality and communication solutions to support patient-centered care.

Siemens also offers the syngo® software platform for all imaging modalities, applications for multi-modality processing, RIS/PACS and computer aided diagnosis (CAD).

“Many organizations follow the ‘If it isn’t broke, don’t fix it’ policy towards IT,” Veach observes. “Due to the short history of healthcare IT, many people still remember some of the horror stories that occurred during the maturing process. Although many facilities have inventory as part of their management systems, most do not use the module to its full capability. There are other tools that are available but have only marginally penetrated the market. Collections management, financial reporting and productivity studies by surgeon and procedures are all available to the market. Most importantly, the rest of the ambulatory healthcare market is approaching 20 percent penetration of electronic medical records, but estimates are that only about 1 percent of ASCs have true electronic medical records. This does not include document management systems.”

An executive order by President Bush in April of 2004 mandated that health IT be implemented into the nation’s healthcare system, stating that a transition to electronic health records was crucial within the next 10 years. Tommy G. Thompson, the former secretary of the U.S. Department of Health and Human Services (HHS), stated at the time, “The benefits that all of us could reap from health information technology are simply too great to put off any longer,” Secretary Thompson said. “The healthcare sector needs to run, not walk, toward realizing this potential. Health information technology can not only improve care for our patients and offer better support for our health professionals, but it can also make health care more cost-effective and improve our public health.”

The President’s executive order also established the new Office of the National Coordinator for Health Information Technology at HHS, and mandated a report in July 2004 outlining how the plan would be realized.

“To realize the benefits of health information technology quickly, we need coordination on a very broad scale. But what is needed most of all is partnerships and cooperation between the thousands of stakeholders in this complex enterprise,” Thompson said. “This is a delicate balance, where the federal role is to lead AND to follow AND to get out of the way, all at the right times.”

1. www.surgicenteronline.com/hotnews/67h188581612360.html 

“Nobody likes change. There are a few simple rules — if you follow them, your upgrade or conversion will be a lot less painful:

1. Get the buy-in from your staff. Explain that you are changing systems and that they will have to do things differently. It is amazing how many conversions get stuck with the phrase, ‘That’s not the way we used to do it’. When people know that there will be a change and it is explained why to them, they generally are much more accepting.

2. Limit the amount of data that you convert from your old system. Do not bring over any financial data. This is a chance for you to start with a clean slate — take advantage of it and make sure you add all the procedures you wish you’d had the last time you installed a new system.

3. If you are converting to a new system, make sure you have acquired the most technologically advanced system that will meet your current needs, and will be there to serve you tomorrow. You don’t want to do this again.

4. Whether you are upgrading your current system or converting to a new system, make sure you have a valid backup of your database. It is not enough to make a backup. You must test it to be certain that it is valid. In fact, it is important to make more than one copy of your backup.”
— Craig Veach, senior vice president of operations with Amkai™ Inc.

“Using SaaS (Software-as-a-Service – also referred to as ‘on-demand software,’) would be recommended, as upgrades are automatic. There is a one-time transition when the service starts and from then on, users will not notice any downtime, and the system is always up to date. Over the course of a year, this saves invaluable time, money, and aggravation, and also offers the benefit of ensuring that you are always benefiting from the newest and best versions of your core tools. (And this removes the hassle of having to push upgrades across a network to workstations or individually at each workstation).”
— Siamak Farah, founder and CEO of Tarzana, Calif.-based InfoStreet 

“Given the importance of technology in today’s ASCs, it is critical that facilities consider routine costs such as hardware and network upgrades, software, and staffing costs when developing their budgets. Again, the IT partner you select should be able to help you to understand what the technical requirements are for the solution you are considering, and what, if any, upgrades to your existing infrastructure may be necessary.”
— Lindsay S. McQueeney, director of product management at SourceMedical

“Do it right the first time. (Or if this is not the first time, get it right THIS time.) The cost of doing it wrong is compounded by months and years of inefficiencies and problems, plus the cost of redoing it right, plus the cost of downtime. Shutting down an OR for several days to install an additional network drop turns a $300 event into a $20,000 problem. There are many options and approaches, but ‘cheap’ isn’t the way to get it done. You’re not running a small city here, but you’re also not running a home gaming network either. You need the right balance of computing horsepower and cost-effective system design. Concentrate on the ‘core’ infrastructure – servers, storage, networking – and make sure you have designed a modular system that can be upgraded and expanded over time. You can always add peripheral items later like scanners, tablet PCs, bigger flat panel monitors, etc. But if you don’t get the core system set up right initially, you face a ‘fork-lift’ upgrade later.”
— Marion K. Jenkins, PhD, Chief Executive Officer, Englewood, Colo.-based QSE Technologies, Inc.