TX Health IT Summit in Dallas
The second Texas Health IT Summit of the year was held from April 22-24, 2010 in Dallas. I attended the Nursing Infomatics and Health IT Policy pre-sessions and the EHR track. The organizers for the summit, the Texas Health Institute, are planning to post presentations from this summit online. As of this date, presentations have not yet been posted, but I am monitoring the site and will update this post when I see the new presentations have been posted. The next Texas Health IT Summit is being planned for Houston later this year. You can register on the Texas Health Insitute's site for notification when the date is set and more information is available.
Below are highlights from the notes I took during the sessions:
Nursing Informatics Pre-session
Mari Tietze set the stage by describing the education, career path and work of a Nursing Informaticist. She noted that only 1% of nurses certified by ANCC are currently Nurse Informaticists. They are the folks often tasked with being the subject matter experts and project managers for health service IT rollouts.
Joni Padden gave an excellent talk on her multiyear project of rolling out an EHR to more than a dozen hospitals. She gave tips on building the internal team that included identifying the superusers who are also strong communicators. They've been rolling the EHR out one hospital at a time. She described how they switched to "big bang" (switching the entire hospital over to the EHR on a specific date and time) after "miserable experiences" phasing the first two hospitals in more slowly. She emphasized the importance of paying attention to the people side of the project ("culture eats strategy every day"). They utilized web self-paced training and "appropriate use" of Facebook in addition to email to assist internal communication.
Chris Allen presented her workflow analysis process. Her tips included starting with the process that is a source of patient complaints, encouraging the practice to get patient feedback at least yearly with a 5-6 point patient survey, and making sure that adequate budget is allotted for education throughout the year.
Pat Bush created Perot's (now Dell's) health informatics program. She described the roles of vendors versus service providers indicating that "vendors cannot afford to be agile and responsive but a service provider can.... Vendors must focus on speed and minimum build implementation to quickly install their product and move on to the next customer." She said the Nurse Informaticist should lead the work with a vendor, not the other way around. She recommended participation in the vendor's user groups.
Susan McBride presented a course map for developing core competencies. Texas Tech is currently applying for a grant to create Texas's first MS program for Nursing Informatics.
Texas Health IT Policy
It was great to meet with major players involved in setting up the Regional Exchange Commissions (RECs) and the Health Information Exchange (HIE) for Texas. This is an extraordinarily dynamic space right now, but I feel good about the calliber of folks who are working together to bring the Texas HIE into existence. Texas is now split into four regions and the RECs have worked closely with one another to address the requirements for obtaining Federal funding. Texas received a little less than half of the funding they requested to cover work over the next four years, so they are going to need to be even more creative to pull off what needs to happen. West Texas has a particularly big challenge ahead because their region covers half of our very large State. The size of their territory was necessitated by the relatively sparse population, but this constitutes an even greater challenge because of lack of broadband and cellular coverage in many areas. Each REC plans to take the lead on a part of the work and share results and best practices with the other RECs. UT Houston plans to do usability testing on EHR vendor software and publish the results. The Texas REC website (www.txrecs.org) is now online.
Keynotes and EHR Track
Kim Slocum returned to present the keynote address on health care spending (see my notes from the Texas Health Summit in Austin). I just finished reading Kim's book, Consumer Directed Health Care: A 360 Degree View, and highly recommend it to anyone interested in understanding how we got where we are today along with our options for creating the health care system we will have tomorrow. It is a good companion text to the currently popular Innovator's Prescription.
Bob Ligon of TMF Quality Institute said that Medical Economics published an estimate that most practices lose $40k/year on average due to coding errors. His top advice to practices researching EHRs is to create a list of requirements and flow scenarios that they need to work and ask the vendor to demonstrate how their system handles the more complex scenarios the practice identifies. Bob emphasized that "show me" works much better than simply asking the vendor "can your EHR do this?"
Joe Schneider said the pendulum has swung among doctors from "I'm never going to do this" to "why can't you give me the tools to do what I do in other areas like e-commerce and banking?" He said there are still a lot of questions and ambiguities in ARRA that have yet to be defined. He cautioned that Medicaid does not equal Medicare. In Texas, Medicaid "meaningful use" uses criteria from Medicare for its base, but the two are likely to diverge. Requirements are also different between hospitals and ambulatory. Joe suggests waiting on preferred vendor identification from the Texas RECs to select a new EHR. Look for his slides, when posted, for highlights of results on the Texas Medical Associations 2009 survey on EMR satisfaction. Joe said the open source EMR community is growing - "good stuff, but not the easiest to configure and use". Joe sited VistA, the platform currently used by VA hospitals, and said that a few other EMRs have plans to move to open source in the future.
A series of short topics during lunch included how social media tools were being successfully employed in health services.
Joe Holtschlag presented EHR ROI and Financing. He cautioned about using time savings as an ROI justification saying that "time does not equal money unless staff is reduced". He added, however, that EHRs can geberally leverage existing staff to support more doctors. He said the primary benefits of EHRs are difficult to quantify: improved quality and continuity of care. He added that most med students are currently working with EHRs and may be less inclined to sign on with a practice that is still using paper. Chris Allen later added in her talk that a strong argument for EMRs is a reduction in malpractice risk.
Dave Marchand provided an excellent set of slides on the fine points in interpreting the current HIPAA security requirements. Any piece of information that can be used to identify an individual including the name of a relative or a car license plate is designated as "Personal Health Information (PHI)" under HIPAA. Data encryption is not required; however, NOT encrypting data increases one's liability in the event of a breach. Access to records is always allowed in a dangerous life-threatening situation; it's termed "breaking the glass".
Indranid Bardhan presented an introductory EHR Adoption, Implementation and Utilization Roadmap. These slides are a good place to start for anyone less familiar with EHRs.
Bob Ligon provided advice to practices getting ready to select EHRs in his two hour "fireside chat". He said that every practice should do the following before implementing an EHR:
- Complete a Readiness Assessment (the form is somewhere on TMF Quality's website; will post the link when I find it)
- Complete a Practice Profile
- Document Important Workflows that will need to be supported by the EHR
