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Stimulating better health

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Print this page by Heather B. Hayes

A few years ago, Sentara Healthcare spent $95 million to build a new cardiac-care hospital in Norfolk. Now, Sentara is investing more than double that amount — $237 million — to build an electronic health record system, the eCare Health Network.
The eCare system will allow authorized personnel to examine (with the patients’ permission) records from 10 Sentara hospitals and 450 other health-care sites (including medical offices, laboratories and pharmacies) in the Hampton Roads region.

“What we’re essentially building is a virtual hospital,” says Bert Reese, Sentara’s senior vice president and CIO. “And we’re spending this money because we think that, ultimately, it will have a better yield on health-care outcomes than other things we could invest in right now.”
Sentara officials expect the benefits of a digital health record system to include reduced costs, higher-quality treatment and saved lives.

“We’ll have one comprehensive record on each patient,” explains Reese. “If you go to the doctor on Friday, and you end up in the emergency department that night, health-care workers there will be able to see everything that went on during your doctor’s visit earlier that afternoon, including any tests that were ordered and any medications that were provided. So there’s no more hunting and gathering for information and it makes the handoff from one physician to the next a lot easier.”

Sentara is not alone in wanting to replace paper charts with digital records. It is among a growing number of hospital networks, physician practices and state health-care agencies that are joining the health IT movement. In fact, Gov. Timothy M. Kaine has provided a series of state grants encouraging such initiatives across Virginia.
Interest in going digital, however, is expected to hit a new level this year, thanks in large part to $20 billion for health IT included in the federal stimulus package, the American Reinvestment and Recovery Act of 2009. The bulk of the federal money, about $17 billion, is aimed at encouraging hospitals and physician practices to adopt electronic health record systems. Another $2 billion would advance other state and local health IT initiatives, such as health information exchange organizations. (These groups assist health-care facilities in exchanging health data.)

The stimulus package also sets aside $1 billion for community health centers, medical schools and federal agencies to implement electronic health record systems.
This injection of money will not miraculously flip a switch that will allow a seamless flow of data among health-care organizations. But it could be a tipping point for doctors and hospitals to begin using electronic health records.
That’s an important first step, says Virginia Secretary of Technology Aneesh Chopra, who has been picked by President Obama to be the nation’s first chief technology officer. “It certainly moves us in the right direction,” he says. “And if this is perceived as a down payment on a larger debate over [health-care] reform, then most certainly, we will surpass the goals that have been set out for health IT, which is near universal adoption [of electronic health record systems] by 2019.”

The health IT movement has been steadily ramping up since the Kaine administration began awarding grants for innovative electronic health applications. The grants have been provided to seven initiatives throughout the state (an eighth is expected later this year), including to three health information exchange organizations: CareSpark of Bristol, MedVirginia of Richmond and the Northern Virginia Regional Health Information Organization.
On their own, several large hospital networks in Virginia also have invested in health IT. They include the University of Virginia Health System, Carilion Clinic, Bon Secours hospitals and Virginia Commonwealth University Health System.

Plenty of hurdles
The New England Journal of Medicine reports that only about 4 percent of physicians and 7.6 percent of hospitals nationwide have basic electronic health record systems. The cost involved, as much as $70,000 per physician, is frequently cited as the biggest hurdle. Doctors also complain that they don’t get much return on their investment. “The burden of the cost of implementing an electronic health record system falls on the physician’s office, but the savings benefits frequently fall back to the insurance carriers and other entities,” says Dr. James Ratliff of Richmond-based Virginia Urology Center. “Then you add in the fact that an electronic health record requires big changes to your practice, and you have to have people to help you service and maintain equipment and systems, and you can see why it’s not an easy step for physicians to take, especially those that have small practices.”

Stimulus package money for doctors implementing an electronic health record system will be calculated according to their Medicare billings. They can receive up to $44,000 each, and a hospital can get up to $11 million, if the system is implemented by 2012.
“They’ve put so much money on the table that it almost takes the cost equation off the table for most physicians,” says David Merritt, a project director for the Center for Health Transformation and a member of Kaine’s Health Information Technology Council. Merritt notes the stimulus also is likely to “kick-start a lot of innovation from a development standpoint so that there will eventually be a product that fits the needs and pocketbook of every type of provider.”

“It is an accelerator,” agrees Mark Tripodi, vice president of health management solutions for Affiliated Computer Services, a provider of health IT systems in Richmond. “Walmart announced recently that they’re getting into the [electronic health record] business. Would that have happened without the stimulus? You put that kind of money out there and a side effect will be a tremendous amount of activity that you probably wouldn’t have seen otherwise.”

Virginia Urology spent more than $1 million several years ago to implement a system at its nine central Virginia offices. The move, says Ratliff, was motivated less by potential cost savings than the need for doctors to have access to records from all of the practice’s offices.
Early adopters like Virginia Urology and Sentara won’t miss out on the stimulus money. Because incentives are paid out over time beginning in 2012, they should be able to recoup some of their investment.

An innovative approach
The goal of the health IT movement is for physicians to be able to retrieve patient information from wherever it’s held in a National Health Information Network. However, there is no agreement on whether this approach is achievable or necessary. Even in Virginia, opinions vary on what type of data sharing is needed.
Reese at Sentara thinks the push for a national network is “kind of pie-in-the-sky thinking, because 90 percent of health care is done locally,” he says. “Interoperability across the country is an interesting notion, but it doesn’t really play to the practicality of how patient care is done.”

Chopra, the technology secretary, is not sure that even a single, statewide health information exchange system is needed. He is focused on getting health-care providers to use software that can share data in compliance with state and national standards.  “We might have a menu of options available, one of which may involve a formal exchange capable of sharing information across the state,” he says.

“But it is unclear to me at this time whether that is the only path to achieving the benefits that we’re hoping to gain from this, which is to reduce costs and improve quality and health outcomes.”
This ambiguity is the main reason why Virginia has taken a more experimental approach to health IT initiatives. Kaine and Chopra have put state resources behind:
• developing technical and data standards,
• simplifying electronic health record selection criteria for small providers and
• expanding broadband access.
At the same time, the commonwealth is encouraging health IT pioneers to address local problems in their communities or state health goals, such as reducing infant mortality rates. The University of Virginia, for example, is testing a telemedicine program aimed at reducing the number of pregnant women in the Shenandoah Valley who go into pre-term labor. Meanwhile, some Hampton Roads hospitals are looking into the viability of personal health records for children of military personnel who are treated by civilian and military health providers. (A personal health record is owned and managed by the patient, as opposed to an electronic health record, which is held by the provider).

From the outside, these efforts might look unrelated, but in the end, Chopra says, Virginia will have applications that deliver on the high hopes of health IT. “We want the innovators to get in the garage, experiment and come up with really cool applications that improve population health,” he explains. “If we seed a bunch of them, it’s likely that several will be very successful and then we’ll want to scale them statewide.” 


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