Monday, December 8, 2008

Obama's Economic Plan

At 11am on Saturday December 6, President-elect Obama announced the three major pillars of his economic recovery plan: rebuild our roads/bridges, enhance our schools including broadband, and deploy electronic health records for every clinician and hospital in the US.

I've written several recent blogs about the cost of electronic health records, the state of interoperability, and my predictions for the early healthcare IT activities of the Obama administration.

I can summarize all my advice to the new administration in one sentence:

Allocate Federal funds of $50,000 per clinician to states, which will be held accountable (use it or lose it) for rapid, successful implementation of interoperable CCHIT certified electronic records with built in decision support, clinical data exchange, and quality reporting.

Not only will this improve care coordination which will lead to better healthcare value (reduced cost, enhanced quality), it will create jobs.

Just how many? For just the Beth Israel Deaconess Community Clinician project, here's the list of jobs we created:

In 2009, we will implement 150 physicians in 75 practices, or 13 physicians in 6 practices per month. The direct staff we'll need are:

Massachusetts eHealth Collaborative: 6 FTEs (5 practice consultants plus a project manager)

Concordant: 9 FTEs (5 on-site assessment/design/deployment/support, 2 technical lead/system architect, 2 project management)

eClinicalWorks: 4 FTEs (3 on-site trainers, plus part of a product specialist and a project manager)

At BIDMC, the project is run by 3 FTEs (Project Director, Technical Lead, Senior Practice Consultant)

Thus we've created 22 jobs for the rollout and support of our EHR project. Multiply this by the number of clinicians needing EHRs in the country and you'll see that the Obama plan will create tens of thousands of new high tech jobs.

When I've discussed the Obama Economic plan with my colleagues, some have said that it's too early to invest in EHRs because they are not yet standards-based or fully interoperable. I believe that commercial EHRs are good enough and as of 2008, we have many real examples of data sharing. Here are the statistics from our work in Massachusetts that includes homegrown EHRs, eClinicalWorks, GE Centricity, Next Gen, Allscripts/Misys, and Epic.

NEHEN - In 2008, we've done 60 million data exchange transactions a year from EHRs, practices management systems, and hospital information systems.

MA-Share - We've done half a million e-prescribing transactions among providers, payers and pharmacies. Every discharge from the hospital and emergency department at BIDMC generates a standards-based clinical summary which is sent electronically to PCPs and referring clinicians. In 2009, we'll expand this to include referral workflow, community to community exchange, and several additional hospitals including Children's.

Massachusetts eHealth Collaborative - We've wired three communities (Brockton, Newburyport, North Adams) with roughly 500,000 patients, 597 physicians in 142 practices in 192 sites, and 4 hospitals including hospital-based laboratories and imaging centers. North Adams went live in May 2007, Newburyport went live in September 2008, and Brockton is 40% complete. Data exchange includes problem lists, procedures, allergies, medications, demographics, smoking status, diagnoses, lab results and radiology results. Standards used include HL7 2.6, Continuity of Care Record/Document, NCPDP Script 8.1, LOINC, CPT4, ICD9, and RxNorm. Over 90% of patients have opted in for community data sharing. Over 300,000 records have been exchanged, all from existing commercial EHRs.

Thus, the EHRs are ready, the standards are harmonized, the architecture is designed, and the only barrier is political. The Obama commitment to a nationwide EHR implementation effort means that 2009 is the tipping point. Let us band together, payer, provider, employer and patient, to make it happen!


Unknown said...

EHR's are ready for the marketplace.

The benfit to patient care is well documented. A patient can be admitted to a hospital just about anywhere in the country and with some minor effort, their records are available to the clinicians who care for them in the ER.

Unfortunately, the $50K price tag is a show stopper for many physicians. The price may be fair and competitive, but when you combine the crappy economy with the attitude that many doctors are waiting for someone else to pay for the have an major uphill battle.

Even if the price comes down 50% many of your collegues will have trouble with the money.

Unfortunately it is the people who do not read this blog that you need to convince.

Unknown said...

Don't forget Kaiser Permanente! Full disclosure - I do work there though on the health plan, not medical side. But I'm also a member. And I've been constantly impressed with how much easier it is from a patient perspective. We live in an old building, and we've been worried about possible lead poisoning for our 10 month old son. My wife took him into the clinic for a blood test on Friday at 5pm. By 9pm we had his routine blood tests back, and by Monday morning his lead test came back (negative - yay). For my own care, I regularly interact with my doctor on-line.

Now, speaking as a professional, I think the business benefits of EHR are understated. The fact that call center reps and nurses can now field routine stuff over the phone is another application of it that can be very useful even if you're not on-line.

Unknown said...

Last but not least - let's not forget about Emergency Medical Services. EMS is the front door of the hospital somewhere between 10 and 40 percent of the time. While EMR (in EMS we call it ePCR - Electronic Patient Care Record) is starting to catch on in EMS, but it isn't going gangbusters yet. As with all of healthcare, there's not a lot of money laying around for us to implement ePCR, but I think it's a vital link in the chain for overall healthcare improvement.

The other stumbling block is getting a hospital to understand why it would be important to take that data electronically from us, but I digress from getting funding to do it...

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