By Donald Burt, MD, Zynx Health
In 2010, only about 15 percent of the nation’s hospitals had at least a basic clinical EHR in place. Thanks to the roll-out of the Meaningful Use program, that number had climbed to 95 percent by 2016. Although Meaningful Use was developed to promote the adoption of health information technology to improve clinical outcomes, the journey has been very painful for most clinicians, including nurses, physicians, pharmacists and others.
Stakeholders may debate the overall success of Meaningful Use, but the program did create widespread IT infrastructures that are now available to support clinical excellence within hospitals and the communities they serve. Healthcare organizations are better-positioned to leverage new and more sophisticated technologies that advance the delivery of high-quality, cost-effective patient care. Furthermore, as healthcare continues to shift from fee-for-service to value-based payment models, there’s never been a greater need for transformational technologies that help providers achieve their clinical and financial goals.
Alignment Of Incentives To Drive High Quality, Cost-Effective Care
A growing percentage of health system revenue and physician compensation is now directly tied to value/quality metrics. In order to maximize reimbursement, health system and its clinicians must demonstrate quality outcomes and cost-effective care.
Quality care has always been a priority for clinicians. Because physicians alone are responsible for ordering services, they’ve also controlled utilization. Newer value-based programs only intensify the significance of quality initiatives and incent physicians to serve as stewards of healthcare resources. More than ever, doctors are highly motivated to seek interventions that drive the best outcomes and avoid unnecessary testing and low-value treatments.
Identifying Optimal Interventions
To order optimal interventions for quality outcomes, physicians rely on scientific literature, opinions of clinical experts, established clinical protocols and their own medical experience. In the past, many clinical protocols were based on historical claims data, which isn’t necessarily reflective of best practices. In addition, expert opinion can be in direct conflict with scientific evidence and thus should be used cautiously or when scientifically-derived evidence is insufficient or lacking. With the pervasive adoption of EHRs, however, clinicians now have more available data to identify the impact of various interventions.
Leveraging IT Systems
Prior to Meaningful Use, health IT systems were used primarily for transactional functions to address billing and finance needs. Since EHRs were created as an afterthought to support billing requirements, clinical workflows were generally clunky and a drain on clinician productivity.
Today’s IT infrastructures and EHRs are more sophisticated and offer additional customization to streamline workflows. For example, earlier systems were configured to alert doctors of potential issues with medication orders. Initially, physicians were bombarded with alerts about low-risk or inconsequential issues, making it difficult for users to identify which warnings were truly important.
Fortunately, these systems have evolved and now users can identify what types of warnings to display and where in workflows they should be presented. Rather than displaying multiple alerts for every medication order, users can suppress all but the most significant warnings that carry the most meaningful risks, such as a known life-threatening allergy to a specific medication.
Hospitals can further leverage IT systems to help physicians select the most cost-effective interventions. For example, a doctor that is ordering a medication or diagnostic test would welcome an alert that advised the prescriber of alternative and equally effective options that also are less costly - if the alert is presented in a manner that facilitates rather than impedes physician workflow.
Driving Clinical And Financial Excellence With Evidence-Based Data
Before the widespread investment in IT infrastructures, the average length of time to get a scientific study into practice was 17 years. With the Internet and advanced IT systems, we can deliver important evidence into the hands of practitioners much more rapidly and efficiently. Instead of continuously replicating interventions that may not represent the “best” course of action, IT systems can deliver to clinicians the latest evidence-based information at the point of care
- and only when it is truly necessary.
Today’s value-based care models demand clinical excellence to maximize financial rewards. To achieve clinical and financial goals, we must equip physicians with tools to identify best practices based on current evidence.
With evidence-based protocols, physicians are better equipped to identify what therapies are more likely to improve both clinical and financial outcomes. Understanding likely outcomes based on evidence, and not simply past care trends, is critical when healthcare systems and providers are both at clinical and financial risk for optimal patient care. Though expert opinions and historical protocols are valuable, they should be applied only when compelling evidence is lacking.
Thanks to Meaningful Use, the country has made massive investments in IT infrastructures. With our new IT landscape in place, it’s time for clinicians to take advantage of what’s been built and maximize IT’s potential to drive high-quality outcomes and financial success.
About The Author
Donald Burt, MD, is a physician executive with Zynx Health, part of the Hearst Health Network. Dr. Burt has a 35-year career in medical management, informatics, and medical practice. Prior to joining Zynx Health, he served as the Chief Medical Officer for PatientKeeper. Before to joining PatientKeeper in February of 2007, he was employed as President of Berkshire Faculty Services, a multidisciplinary physician practice group associated with Berkshire Health Systems. Dr. Burt also served as a Vice President of the McKesson Corporation, Vice President and Medical Director of Health New England, and practiced Internal Medicine and Geriatrics. He is a graduate of New Jersey College of Medicine and completed his residency in Internal Medicine at the University of Massachusetts.