The Rhode Island health care delivery system, driven by the leadership of its two largest hospital systems, is moving ahead with rebuilding and upgrading their health IT systems, which promise to have a major impact on the how care is delivered and changing the business model of health care.
Providence Business News asked Dr. Cedric J. Priebe III, senior vice president and chief information officer at Care New England, to detail how EHRs and health IT are changing the dynamics between patients and providers.
PBN: What do you see as the cost savings that can be achieved through EHRs and a more unified health IT platform at Care New England?
PRIEBE: Much has been written about the anticipated and realized cost savings or return on investment made in EHR systems. I believe EHR systems are a worthy investment for hospitals and other health care provider organizations as they do provide efficiencies – standardizing the processes of care, reducing duplicate services as well as improving the quality and safety of care through the provision of evidence-based decision support for the providers.
These benefits accrue over time and do not immediately translate to cost reduction, since the investment in technology and people to implement and support the technology is significant.
I believe that the health care organizations that make investments in EHR technology and develop the capability to improve care through their EHR technology are best positioned to adapt to the changes in health care delivery.
PBN: What role do you see the patient playing in the new interconnected medical system?
PRIEBE: I regard patients and their families as critical members of the care team. There is good evidence that patients’ activation in their care process is a strong indicator for positive outcomes.
Recent advances in IT have created new opportunities to engage patient and their families in the care process. For example, the Internet provides patients with a new source of knowledge and reference about medical conditions.
The challenge is to identify well-authored content that contributes positively to their understanding. In addition, web-based social media sites have created new venues for patients to connect with communities of fellow patients of rare or chronic illnesses.
Health care providers have also started to extend their services beyond their traditional physician venues of hospital, clinic or office using web and mobile technology applications that can reach the patient at any location.
Though early in our experience with this type of telehealth, these offerings have potential for significant impact on patient’s satisfaction and community wellness. Our challenge will be to give patients the information and services they want through these virtual encounters and not further fragment the patient's experience of care.
PBN: Will Care New England be developing its own internal information exchange through which to mine data and enhance its ability to better manage population health?
PRIEBE: Care New England, like most multi-hospital health systems, has invested over many years in IT infrastructure and applications that allow us to document and coordinate care within and between our multiple entities that include hospitals, physician offices and a home health facility.
We have also created a variety of interfaces between our IT systems and those of many affiliated physician groups and other service providers. This will definitely enable us to manage population health within Care New England.
That said, this represents a complex set of interconnections with a high volume of data flowing between care entities, but I would not categorize this as a health information exchange on the scale similar to our “public” health information exchange, called CurrentCare, that is operated by the Rhode Island Quality Institute.
CurrentCare is intended to take data submissions from all Rhode Island hospitals, lab and other diagnostic service providers and physician practices for patients who consent to enroll or participate in the HIE in order to assist in the coordination of their care across all providers and health systems in the state.
Care New England is an eager and enthusiastic participant in CurrentCare as both data-submitting partner and recipient or viewer of data. It is truly a public asset.
PBN: How would Care New England’s new EHR system come into play if there the current H7N9 flu outbreak in China were to become a global pandemic?
PRIEBE: A well-designed and implemented EHR, such as the EpicCare EHR being implemented in the practices of physicians employed by Care New England or the Cerner Millennium EHR that is currently implemented in the Care New England hospitals, can assist both the public health surveillance of a population for such a pandemic outbreak as well as the preparation for and response to an outbreak.
In 2010, Care New England participated in a consortium that submitted de-identified aggregate vital sign and laboratory values for use by the Centers for Disease Control and Prevention to detect local outbreaks during the H1N1 pandemic in that year.
Care New England also routinely submits public health surveillance data from our EHR to the R.I. Department of Health.
To help prepare for or respond to any type of public health emergency, an EHR is a great way to quickly implement and communicate new diagnostic or therapeutic interventions that would be indicated in an emerging pandemic. Changing the practice behavior of a large numbers of providers across multiple practice settings is possible with a fully implemented EHR. This would be challenging, if not impossible, in the paper medical record world.
PBN: What are the next benchmarks for meaningful use in the performance of its EHR systems that Care New England will seek to meet?
PRIEBE: The Care New England hospitals eligible for the federal meaningful use incentive program achieved Stage 1 objectives and incentive payments in FY 2011, the first year of the program.
This achievement was maintained in fiscal 2012, and, now in its third year, Care New England hospitals performance against the Stage 1 meaningful use objective measures continues to track favorably.
We are now planning ahead for the Stage 2 meaningful use objectives that were specified by the Centers for Medicare and Medicaid earlier this year and that will apply in FY 2014.
In Stage 2, several objectives that were also in Stage 1, such as the use of our EHR for computerized physician order entry, electronic prescribing and the performance of medication reconciliation, have a more challenging definition of the measure.
Stage 2 also introduces new objectives, such as those to promote patient engagement, which will require the eligible hospital to offer patients being discharged from the hospital access to an electronic version of their health care information.
The objective also specifies that a number of discharged patients must view, download or transmit their electronic information to another health care provider. This will challenge hospitals and providers to intensify and expand the use of our EHR systems with the ultimate goal of achieving the nation's Triple Aim goals of better health of populations, better health care experience by patients and lower per capita health care costs.