Inner workings

How has hospital infrastructure changed in 10 years?
By Chris Nerney
12:00 AM

Health IT wasn’t quite in the dark ages in 2003 – but it sure was close.

“I was talking recently with a man who told me about visiting an endocrinologist 10 years ago,” said Cheryl Stephens, CEO of Community Health Information Collaborative, based in Duluth, Minn. “The doctor kept a little spiral-bound notebook in his top pocket that had a page for every patient, with tiny notes about whether this hormone had gone up or down, etc.

“And the guy asked the doctor, ‘What would happen if you lost that book?’ And the doctor said, ‘Well, I give that book to my nurse every night and she takes it and copies it onto a piece of paper and enters it into the patient’s record.’”

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Which said something about technology’s place in healthcare back when Healthcare IT News launched.

“In 2003, fewer than 5 percent of hospitals in the U.S. had any form of electronic records,” said David Brailer, MD, who became the nation’s first ‘heath information czar” in 2004. “A smaller percentage of doctors’ offices had them, probably less than 1 percent.”

Brailer was appointed national coordinator for health information technology under an executive order by President George W. Bush, as part of a 10-year goal to modernize health technology. Though he spent just two years on the job before becoming CEO of private equity firm Health Evolution Partners, Brailer helped kick-start bipartisan efforts, in Washington and on the state level, to build an interoperable, standards-based Nationwide Health Information Network.

“It was something everyone knew was inevitable, but the fire had not been lit,” he tells Healthcare IT News. “People were frustrated with paper records. Patients were frustrated not having their information. People who wanted to do health reform wanted to find ways to make a difference, but couldn’t. More than anything, the efforts to bring cost efficiencies to the industry simply couldn’t be done without it. So it was an idea whose time had come.”

Nine years later, Brailer said, “About 85 percent of hospitals now have electronic records in place or almost in place, and about 60 percent of doctors’ offices have them.”

While much more progress clearly needs to be made to modernize the use of information technology in the U.S. healthcare system, Brailer said, “It’s breath-taking to me to see it happen. It’s much grander, it’s much more significant, much more sweeping and global than what we ever thought it would be.”

Getting online

By 2003, computers long had been a presence inside major medical facilities and healthcare organizations, used primarily for basic patient data entry. In clinics and doctors’ offices, healthcare providers might haul a cumbersome laptop from one room to another as they make rounds to see patients.

But the primary “technology” for patient data storage remained paper, in large part for cultural reasons.

“If a physician had to sign off on a discharge summary, it had to be printed for them because most weren’t going to sit down in front of a computer and read it,” said Stephens.

And even if a health organization cobbled together its own system of electronic records, those records typically couldn’t be accessed from outside the network. Further, there were gaps and inefficiencies in how EHRs were kept and shared.

In recent years, the federal push to modernize healthcare systems has prompted many large health organizations to dump their older, home-brewed electronic records – even pioneering, respected systems – for platforms built by vendors specializing in healthcare systems.

Boston-based Partners Healthcare, the largest healthcare provider in Massachusetts, for years has relied on systems dating in large part back to the 1980s at Massachusetts General Hospital and Brigham and Women’s Hospital, two of the preeminent academic medical facilities in the country.

Faced with the task of integrating and updating records from three dozen hospitals and community health centers and more than 6,000 doctors in the Bay State, Partners last year signed a $600 million contract with Epic Systems Corp. of Verona, Wisc., to roll out a single system over a 10-year period that would allow access by all Partners care providers to a patient’s up-to-date electronic health records.

And just three months ago, Intermountain – which provides healthcare through more than 1,000 medical professionals at hospitals and clinics throughout Utah – announced it will replace its existing homegrown system with one built by Cerner Corp. of Kansas City, Mo.

Marc Probst, vice president and chief information officer for Intermountain, said the nonprofit provider opted for Cerner because its platform is based on open architecture.

“There clearly is a lot more emphasis on data sharing, and the importance of it,” said Probst. “Certainly, Direct, eHealth Exchange, and Care Connectivity Consortium type efforts have increased the ability to exchange standard CCD/CDA data and this is helping. Also, proprietary networks like state exchanges and vendor-based solutions such as Epic and Cerner are also helping data sharing.”

For analytics, a beginning

The relative lack of EHRs in 2003 essentially ruled out not just access to records, but efforts to analyze large sets of patient data to detect trends and uncover metadata. As the national health network continues to build out, we’re finally getting to a point where healthcare may be able to truly leverage data analytics in a meaningful way.

“Big data is contingent upon having big data,” said Brailer. “Not just big, but clean data, useful data, validated data, timely data -- and that’s just coming together now.”

While he notes that “big data is touching the insurance industry and is in big pharma,” Brailer said he doesn’t “see it happening much with providers yet. But we know how that movie will end, and there’s going to be a big movement.”

First, though, privacy concerns must be addressed.

“Many of our members still don’t want to have their data stored in a repository,” said Stephens. “They think they can’t get back into it and fix it if they find a problem. I think it will happen, but until ACOs (accountable care organizations) become very pervasive, data analytics is still a closed system.”

Probst agrees that “the use of analytics continues to grow, but it is still early.”

“An electronic data warehouse, or other analytic engine, is simply the beginning and frankly, the easy part,” he said. “The bigger challenge is creating the environment, organization and talents for data analytics.”

Analytics, he added, “needs to be culturally understood and accepted – and this comes through top-down leadership and example. There is still a lot of runway in front of our industry as it relates to effective use of analytics.”

Medical made mobile

Among the biggest technological changes for caregivers over the past decade has been the rapid proliferation of mobile devices – particularly the introduction of Apple’s iPad in 2010. While medical professionals have been using laptops for years, tablets took medical mobility to another level by delivering critical medical data to caregivers in the field.

“The ability to get information much closer to the patients and providers has helped in improving care processes and it has saved lives,” said Probst. “Business executives have been able to do their jobs from just about any location with their cell-phone and laptops. In medicine, now clinical care givers and other support professionals have the same ability to get data where they are and quickly assist in care giving, even if they are great distances away.”

While Android devices are appearing in more caregivers’ hands, the iPad remains the tablet of choice for the majority of medical professionals. Among the specific uses of the iPad that are helping to revolutionize patient care:

Accessing and input patient information at the point of care;
Providing a familiar digital portal to patients for submitting medical and personal information, as well as providing feedback on quality of care;
Providing information to visiting home healthcare workers with tablets;
Enabling wireless collection of data from home medical monitoring devices.

“Physicians are able to get into EHRs from anywhere now, and I think it’s making things far more efficient,” said Stephens. “Home health is going to become more of a center of excellence because of the devices we’ll have in patients’ homes that can communicate via wi-fi connections.”

The next mountain

The state of healthcare information technology has improved dramatically over the past decade as the majority of patient records have entered increasingly connected electronic systems. Probst, while optimistic about the future, isn’t satisfied with the present.

“In the end, the basic requirements for strong national standards will win the day and data liquidity will be possible,” he said. “Until then, we are where we are – which is far inferior to where we could and should be.”

“There still needs to be a push to get the rest of the doctors’ offices done, but we’re way past the tipping point,” said Brailer. “Doctors don’t want to do business with other doctors who don’t have electronic referrals, they can’t communicate back electronically.”

Summing up the changes in healthcare IT over the past decade, Brailer said, “We had two goals. To get these information tools in place, and then to tie them all together into one cohesive set of information, and that has not been done. So we don’t have the integrated lifetime personal record we sought to have, and that’s the next big mountain to climb.”