Editor's Note: Dr Robert Laskowski of Christiana Care Health System (photo and bio above) is a participant in today's National Press Club briefing on meaningful use of health IT, cosponsored by Health Affairs and the Health Industry Forum at Brandeis University. The post below highlights salient points of Laskowski's presentation and supplements his discussion.
The recent release of regulations that guide billions of dollars of government investment for the “meaningful use” of electronic health records poses many challenges to the current practice of medicine. The concept of “meaningful use” embodies a call to action to use information effectively to create a new value proposition for health care – improve safety and quality, and reduce costs.
This call to action is directed to all health care professionals, and for many physicians it represents a sea change. Physicians largely direct the health care of patients. The nature of our “orders” forms the basis upon which systems of care are organized. “Meaningful Use” of healthcare information will not only shape the form of our “orders” but also “transform” care by helping shape new systems of care to carry out our directions.
The “meaningful use” goals of: medical practice based on the best available evidence, ease of professional communication, universal access to timely medical information, chronic illness management, and population based approaches to practice demand new more “systematic” approaches to practice. “Meaningful Use” is not just the use of information technology, but its use in innovative, more informed ways. The current organizational structure of physicians in the United States, largely small groups of independent practices, makes it difficult for physicians to effectively lead system changes that innovations in health IT make possible. For physicians to be effective leaders we will need frameworks in which to assert physician leadership and partners who can overcome the limitations of the current fragmentation of medical practice. These frameworks and partnerships can, at least in part, be supplied by large, community-based health systems.
As chief executive officer, I’m privileged to guide one of the largest health care systems in the United States, Christiana Care Health System — a regional, community-based, non profit, non-sectarian academic health system in Wilmington, Delaware. I am also privileged to live in Delaware, a state noted for its traditions of cooperation and civility, and a leader in implementing a functional statewide health information technology network (the Delaware Health Information Network or DHIN). I have the additional good fortune to work with extremely talented physician colleagues on the medical staff of Christiana Care, the majority of whom are in small group private practice.
I believe there are three practical questions that must guide our efforts to meet the challenges and opportunities posed by the HITECH “meaningful use” goals. First, how do we get all health professionals effectively on the same network? Second, how do we help doctors, especially community-based private practice physicians, afford the start-up costs and navigate the “system changes” of meaningful use implementation? And third, how do we assure that all doctors—new physicians, but especially physicians already in practice (who didn’t grow up with computers)—fully benefit from the use of technology?
Three Health IT Questions With A Common Answer: Hospitals And Health Systems
While all three questions have many complexities, we believe they all share one answer in common: hospitals and health systems. The release of meaningful use regulations has created a leadership moment for America’s hospitals and health systems as well as for physicians. No other organizations in our country are in a better position to partner with physicians and help facilitate the successful realization of Health Information Technology for Economic and Clinical Health Act (HITECH) goals than community–based hospitals and health systems.
Let’s first consider the central role hospitals play today. In many communities across America, including Delaware, our hospitals and health centers are increasingly the largest employers, with the widest network of public and private partners, and the greatest ability to catalyze jobs, growth, and economic activity. While medicine is rapidly moving beyond the four walls of our hospitals to solve the many public health challenges we face as a society, community health is still anchored in the hospital and will be as we continue to build new ambulatory based programs and systems of care. All community doctors refer patients to hospitals, and have patients referred to hospitals. The natural networks that exist between hospitals and community primary care physicians and specialists are precisely the same paths on which innovations in information technology must tread. It makes sense to have hospitals and health systems as catalysts in the development of information networks to coordinate care that they already help to organize.
Now, let’s go back to our three questions. Our experience in Delaware is that hospitals are in an ideal position to help address all three.
Getting everyone on the same network. First, how do get everyone on the same network? In Delaware, it was the leadership of community health systems like Christiana Care, in partnership with government and other stakeholders in the private sector that enabled us in Delaware to bring DHIN online in 2007. The health systems of Delaware provided not only the monetary investments, but also the professional leadership and in-kind technical support to surmount the many practical barriers to implement a statewide health information network. Without the leadership of the state’s health systems there simply would be no DHIN. And, without the DHIN, our ability to transform healthcare to make it more effective and less costly for the people we serve would be markedly reduced.
Helping with start-up costs. Second, how do we help doctors, especially private practice community physicians, to adopt new health information technology. As a result of the new incentives, doctors who demonstrate meaningful use of electronic health records could receive incentive payments as early as 2011. That’s good news—but how do you convince a community doctor facing cuts in reimbursements to make significant up front investments in electronic health records in the hopes that he or she may receive incentives in meaningful use reimbursements two years from now?
Our answer at Christiana Care is: we will help. We believe the potential of community benefit here is so significant, that we are investing significantly as part of our overall “strategy of service.” Working with our regional extensive center, Quality Insights of Delaware, we are investing significantly in community-based primary care practices to help physicians with start-up costs and system change. This rapid adoption pilot program is now underway. If providers can prove meaningful use they will get the federal incentives. We simply want them connected to us, to other health systems where they practice or where their patients receive care, and to each other to help improve the health of our community. We see this initiative as a strategic opportunity to lead and to use our managerial expertise and financial resources to partner with physicians.
Ensuring that all physicians benefit. Lastly, how do we assure that all physicians, new and experienced, fully benefit from the advances in health information technology? Experience has shown that for physicians who struggle to keep up with the enormous daily advances in medical knowledge and who deal with the urgency of the immediate problems of dozens of patients a day, the challenge of learning “the language of health information technology” is often one challenge too many. This is one reason why the majority of American hospitals have yet to implement Computerized Provider Order Entry. We are in the 90th percentile of hospitals that have developed computerized provider order entry. In March of 2010 we achieved yet another milestone, Christiana Care, after years of careful planning with colleagues on the medical staff, joined the ranks of the 3.8% of American hospitals with a closed-loop medication process.
For new doctors— who, as residents, spend 1-5 years in our health system learning their professional skills, we recently began revamping our residency and fellowship program to hard wire meaningful use training into the curriculum. Our class of more than 95 medical and dental residents and fellows that entered in July of 2010 will not graduate without being certified in computerized provider order entry training and the use of medical informatics to practice more safely and effectively. For established physicians, we are upgrading our continuing education program—starting with the physician practices that receive grants—to find creative ways to help busy doctors learn this vital new skill. Rather than forcing physicians to come to us, we are creating a training program that will bring our information specialists to them, training them in their offices, with their technology.
My colleagues and I at Christiana Care believe that through efforts like this, we can partner with physicians and engage them fully as leaders as we work together making the patient care safer, of higher quality and affordable for all. In our efforts, fortunately, we realize we are not alone. In partnership with our physician colleagues, nobody is in a better position to lead this transformation of healthcare than America’s hospitals and health systems.