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Health information technology is more talked about than really understood. Part of the reason for this is that providers and their staffs usually interact with a restricted subset of health IT – the Electronic Health Record (EHR), the radiology imaging system, the billing system, and so forth. Only the organization’s IT staff and Chief Technology Officer (CTO) are in a position to see the big picture. Even they may not see all of it. This blog post tries to cover at least the larger components of Health IT.
What’s The Most Important Piece?
The EHR is arguably the central component. In an ideal system, all the information a provider or patient wants, from demographic information to lab results to radiological images to records of office visits should be there. Making the EHR the centerpiece is one way to avoid “siloing” of information that makes research and analysis difficult or impossible. If the EHR is complete, every other component—statistical reporting, radiology, billing, appointment scheduling, and lab results are present, and can be used to drive other systems.
This, of course, is an ideal situation. One barrier to accomplishing this is money. Putting in a new EHR system can cost a lot. Recent figures for installation are around $33,000 per full-time physician. Maintenance runs $1,500 per month per full-time physician. A hospital system with 500 physicians is looking at a minimum of around $17 million for initial installation and around $9 million for annual maintenance.
If the system is hosted in the cloud, storage, input, and “egress” fees (sending data to the providers for use from data stored in the cloud) have to be considered. Cloud hosting can run around $165 per “seat” per month, where “seat” is a computer linked to the cloud. Assuming an employment of 3,000, this will run around six million dollars per year. But cloud hosting may well be cheaper than buying and maintaining hardware and paying a large IT staff. Cloud hosting offers better security and offloading a lot of IT headaches as well.
What Are Some Other Components?
There will be radiology and lab subsystems, at least, plus billing and accounting. How tightly these are integrated into the EHR system and the cloud will vary. Analytical systems may include big data handling and artificial intelligence. Of course, if a physician is a hospital employee or a member of an affiliated group, it makes sense for their in-office IT systems to be integrated with, or be part of, the hospital IT operation.
What’s So Great About AI?
Artificial intelligence (AI) is still in its infancy. Studies have shown that AI systems are better at reading radiology imagery than human radiologists, and of course better at catching prescription errors and medication conflicts. But many legal questions, particularly about liability, remain unanswered. In addition, AI is intelligent only within a limited sphere. It will be far into the future before AI is able to display the kind of general intelligence that a human physician can bring to a patient.
What AI is good for now is dealing with well-defined tasks and helping to narrow down the “unknown unknowns” – interactions, sources of error, and opportunities for improvement that humans would never have suspected. Their principal role in the near term most likely will be relieving the “cognitive overload” that all physicians, no matter how narrow their specialty, have to deal with.
What Are Patient Portals?
Patient portals – interfaces, usually web-based, are systems that allow patients to see their lab results, talk to their providers, make appointments online, find providers, and do other things that patients would normally do over the phone. If properly designed and implemented, they can have a major impact on operational efficiency and patient satisfaction. On the other hand, a patient portal that is too complex and too clunky to be easily used can drive patients away.
What Are The Incentives For Using All This Stuff?
The Affordable Care Act (ACA) and the Health Information for Economic and Clinical Health Act (HITECH) provide billions of dollars for providers who implement EHR and other health IT systems and “meaningfully” use them. They are a de facto requirement for any provider which receives Federal funds, which is virtually all of them.
What Are The Downsides?
The biggest one, of course, is the expense. Even though it is large, it may well be cheaper than maintaining one’s own equipment and IT staff. It also permits renting out a lot of headaches. The downside is that, for HIPAA purposes, one has to devote as much attention to the vendor’s security practices as to one’s own. Also, system modifications and customizations necessarily involve the vendor’s staff and consulting services, which may be very extensive.
And, of course, there is training. This is not so much expensive as extensive. The example of one Pennsylvania health system that changed EHR systems three times in one year probably represents an extreme outlier, and training the entire staff three times in one year was no doubt a task worthy of being avoided if at all possible.
Finally, if the organization is moving from primarily paper-based systems to health IT, the organization’s culture needs to be adjusted, and the transition may be wrenching. Still, the advantages of health IT outweigh the disadvantages, and all providers should be making the switch as soon as possible.