Is the US IT Program Heading in the Right Direction?

With the huge impending investment in the US, the Vendor community provided feedback to the Federal Programs as reported in Health Data Management. Many of the challenges are the same as Canada - e.g. increasing demand for services, but diminishing returns due to restrictions and limitations in funding the healthcare system, insufficient focus on usability to make the EMRs really function smoothly in the practice setting etc.

Some examples cited in the article are:

• Physicians will not purchase productivity-decreasing software--particularly now, as they face increasing demand and diminishing reimbursements. They reported productivity losses as high as 40%, and the impact did not diminish over time.
• Template-based EHR notes provide little value--recipients report that they cannot find the important information buried within lengthy, non-filtered documents. These notes do not contribute to better patient care because they often sound the same, lacking nuance and personalization. Frequently ignored, they may in fact decrease quality of care.
• Required point-and-click data input by physicians detracts from their ability to focus on the patients and is a waste of the most valuable healthcare resource--physicians' time.
• Specialists find the primary care focus of the software and of the CCHIT requirements--even the proposed ARRA 2011 certification criteria--not relevant to their needs.

Read the full article: Vendor Exec to Feds: Change Course.

The Federal Advisory Committee Blog is a useful resource to read commentary from users of EMRs (EHRs) that do or do not work.

Is the US on the right track? Is it possible to address the issues raised or at least some of the issues in a way that will lead to success? How relevant are these concerns in Canada e.g. the issue of specialist needs being met by solutions that are focused on primary care?

Add your thoughts or comments by clicking on the 'Comments' link below

Comments

[Alan Brookstone for Doug Diedrich]

The following comment is published on behalf of Doug Diedrich: Ironically, a proven EHR system already exists. It's called VistA (no, thankfully not Microsoft's product of the same name)and the beauty is that it is predicated on an open source code. The development of this open source EHR occurred from 1994 to 1999, when Dr. Kenneth W. Kizer, MD, MPH served as the Undersecretary for Health in the U.S. Department of Veterans Affairs (VA). In this role, Dr. Kizer was the Chief Executive Officer of the VA healthcare system, the largest provider of healthcare in the nation, managing an annual budget of more than $20 billion, approximately 200,000 employees, and more than 1,300 sites of care. He was the chief architect and driving force behind the radical transformation of VA healthcare that occurred between 1995 and 1999.

[Alan Brookstone]

I would like to point out a May 2009 report that was published by the Office of the Inspector General within the Veteran's Administration entitled: Audit of VA's Management of Information Technology Capital Investments. The report indicates that the VistA system has its challenges (as does any large IT implementation).

As reported by Joseph Goedert for Health Data Management:

The OIG conducted an audit after the VA failed to meet a deadline to submit documentation to justify funds for I.T. capital investments for budget year 2010. The documentation is called Exhibit 300s.

In a new report, OIG concludes that the VA's Office of Information & Technology "did not have effective policies, procedures and management controls in place to ensure that the VA managed its I.T. capital investments effectively, efficiently and in accordance with applicable criteria."

Further, the I.T. office has not implemented controls to ensure it does not miss future Exhibit 300 submission deadlines, according to the report.

"More importantly, OI&T's delayed submission of VA's Exhibit 300s signifies a much broader and more serious issue--VA's inability to adequately manage and ensure effective oversight of its I.T. capital investments," the report states. "For example, OI&T has not fully defined and documented new centralized management policies and procedures needed for effective I.T. capital investment management.

OI&T has also not clearly defined the roles of I.T. governance boards responsible for facilitating budget oversight and management of I.T. capital investments or established the criteria the boards will use to select, review and assess I.T. capital investments."

The concerns of the VA's Office of Inspector General are timely as the VA strongly considers replacing its core VistA patient care information system with commercially available software.

For the full OIG report, click here