Archive for the tag 'Immunizations'

Day 2: Health Information Technology – Creating Jobs, Reducing Costs, & Improving Quality – A National Conference Hosted by Governor Deval Patrick

Last Friday, I attended Governor Deval Patrick’s HIT conference in Boston and present my own musings and takeaways from day 2 of the conference. Be sure to check out Dr. John Halamka’s reactions from last Thursday morning’s CEO summit at the Govenor’s HIT Conference.

Keynote from the Surgeon General – Vice Admiral Regina M. Benjamin

  • She covered how Hurricane Katrina affected her community in Alabama and the fact that due to the natural disaster, they were reliant on pharmacy chains to provide a record of what medicine the patients were taking.
  • She also touched on a story of how members of her clinic were drying out the patients records after Hurricane Katrina and after they had them completely dried; a fire burned the entire clinic down. This brings to light the need for disaster recovery and collocation in some circumstances. Galen Healthcare Solutions proudly offer a downtime solution in its VitalCenter product.
  • After the fire, Bentley college students came down to assist and one of those classes contacted the president of e-ClinicalWorks and convinced him to donate the EHR – integrated with both labs & referrals
  • She stressed that prevention is the foundation to the National health System and as such we should be incentivizing prevention.
  • She also mentioned how the EHR played a major role in prevention of errors

Getting Clarity – Developing Effective Health IT Policies and Standards

  • Need to integrate claims and clinical data to provide total model for exchange
  • 15 cents of every dollar in healthcare goes to administrative overhead
  • Two key issues for data exchange – identity and consent
  • Public Health entities currently receive data, however not every public health entity has the infrastructure to receive data
  • How do we pull quality measures out of unstructured text?
    • Analogy of querying for alcoholics, but free text match is returned about using alcohol to swab skin before applying needle.
  • The tough part of concerning clinical quality measures is the balance of structured and unstructured data
  • Healthcare delivery is complex in that there is heavy fragmentation – 80% are solo or two physician practices
  • Dr. John Halamka mentioned that we are the stewards of our own data and architecturally that is the design of the system

Jobs, Jobs, Jobs – Health IT, Business Opportunities, and Job Creation

  • Healthcare workers do not have not enough IT in their educational curriculum
  • Howard Messing, the President of Meditech mentioned that in Massachusetts in particular the cost of living is a barrier – Meditech actually has commuters from Atlanta.
  • Girish Kumar Navani, CEO of e-ClinicalWorks indicated that they currently employ greater than 1000.
    • He anticipates hiring 500 new workers over the next 2 years for programming and business analyst positions
    • He also mentioned the analogy of the electrical socket – broadband network need to be as irreplaceable in physician office as the electrical socket.
    • He believes there is a need for a  new type of worker, the knowledge worker, who understands workflow and is able to analyze and make better decisions about population health
  • Richard Reese, Executive Charmain of the Board, Iron Mountain, anticipates helping hospitals clean up paper mess.
    • He mentioned non-compliance in healthcare IT to storage and backup standards
    • Lesson in compliance can be drawn from Wall Street years ago and that healthcare organizations must design for workflow, but compliance as well
  • Brad Waugh, President & CEO at Navinet, indicated that the network his company providers connects payers and providers, saving $800 million per year.
    • They currently require Microsoft .NET certified engineers and have over 30 openings
    • He indicated that the educational system must produce the folks needed in healthcare IT and currently it is just not doing so domestically
  • This discussion brought to light a deeper seeded issue in American society in that as a society we are not pushing computer technology anymore as it is no longer the glamorized industry.
  • There is a major need for qualified issues and it is a supply versus demand issue with the roots in education and society.
  • One member of the audience mentioned that the goal of healthcare reform is to eliminate costs and the irony is that in a sense we are creating jobs to eliminate jobs
  • Another member of the audience commented on the arrival of programs for night healthcare professional courses, much like it was the trendy thing to get a night MBA in the 90s
  • Finally the point was made that by the middle of the current decade, we will be facing baby boomers hitting Medicaid and the amount of care they need is incredible. With less dollars, we will need to re-engineer the system and what could come as a result is care rationing

Panel: Successful HIEs – How They Did It and How It Helps

Fallon Clinic HIE

  • Emergency care was the highest reason for HIE usage
  • Some quotes from physicians on the value the HIE provided
    • “Importing the CCD expedited documentation”
    • “Reduced need to ask patients questions”
    • “Expedited verification of medication and allergy list”
    • “Saved time”
    • They estimate phone calls were avoided for 75% of hospitalist and were extremely beneficial for new patient visits
    • They estimate they spent 3 years and $3 million learning and developing “trust” and $1M in building and implementing in the final 2 years
    • Lesson learned:
      • They pre-registered all of their patients in the community (bulk-load) and this helped with performance as they didn’t have to query the state
      • They felt the key to sustainability was to reduce operating expenses
      • Each organization in the HIE was responsible for server maintenance – ends up being $2000/year/organization which represents rounding error in most healthcare IT budgets
      • Key points – earn trust – utilize real-world workflows – value of low cost

Indiana Health Information Exchange

  • Federated data model – 62 hospitals – 3 billion structured results – doubling time of 4 months
  • They meet the providers where they are whether it be delivery of data to the EHR or physicians receiving data as PDF or view into a portal
  • They view sustainability in the sense of funding via offering services
    • work with public health services for syndrome surveillance and track immunizations
    • Their business model for sustainability is such that scale is needed and again they emphasized avoiding grants for operational costs.

NEHEN

  • Their sustainability model is such that their organization provides governance – decide what has value – much as a board of directors would
  • Federated model works better than centralized – more accepted in the marketplace
  • Lessons learn include integrating processes across the enterprise
  • The case of the transfer of information to public health is needed to sustain HIEs as well as the capability to sell other products within the network.

Immunization Data Exchange with the EHR

In light of the highly publicized widespread outbreak of the Swine flu, it is certainly pertinent to touch on how organizations may utilize an Electronic Healthcare Record (EHR) data exchange from the EHR to an immunization registry to contribute in the effort to control this pandemic. Resolutions by the American Medical Association (AMA) and the American Osteopathic Association (AOA) note that the “lack of accurate immunization records represents a major reason for missed opportunities to vaccinate” and “immunization registries offer a cost-saving solution that ensures access to accurate immunization records at every visit.”

It is well-documented that registries can save health care provider money by drastically reducing the time it takes to pull a child’s medical record, review his immunizations, enter the new shots, and re-file the record. However, a stand-alone registry application requires duplicate data entry in the case where an EHR acts as the practice’s clinical data repository. In situations where a stand-alone immunization registry solution is already instituted in a practice, productivity increases of 30 to 50% can be realized by integrating the clinical repository system, namely the EHR, with the state registry via a data exchange.

Introduction

An immunization data exchange facilitates the share of data between the immunization registry and the EHR by bringing registry information into the EHR and also sending data to the immunization registry with every administered immunization. Integrating the EHR with the immunization registry offers the capability of sustaining high immunization rates and low disease levels via sharing of clinical data. As a result of these immediate benefits, providers will also realize many long-term benefits such as a reduction in paperwork, staff time and costs associated with immunization related activities. Most importantly though, are the direct patient outcomes in that the immunization data exchange prevents unnecessary (duplicate) immunizations.

Benefits

  • Compliance – On average, less than 80% of shots given are entered
  • Data Accuracy – Over 15% error rate when completed by clinical staff
  • Data Availability – 50% of 2 year olds have 2 or more providers
  • Provide record consolidation of immunization information
  • Facilitate management of immunizations so that children receive only the vaccines they need within the appropriate time-frames
  • Decrease time spent by office staff seeking immunization histories
  • Generation of timely immunization reports to assist with reporting requirements and other quality improvement initiatives.
  • Elimination of redundant entry of patient data in both EHR and registry application
  • Immediate availability of immunizations to the enterprise.
  • Decreased risk of patient matching errors (name misspellings, missing dates of birth, etc)
  • Custom reports can also be created and deployed to supplement current paper processes for documentation of immunizations (for instance a summer camp requires all medications, immunizations, allergies be documented)

immunization ehr interface

And perhaps the biggest benefit is that many groups are able to negotiate with the immunization registry to subsidize the cost of the data exchange. Since the data exchange presents many benefits from their point-of-view – the practice actively contributes to the patient immunization record via a data exchange from the EHR to the registry – the registries are often happy to provide financial incentive for practices to participate in an electronic data exchange.

Cost Savings

A study published in the American Journal of Preventative Medicine found that the annual cost for a practice to participate in a registry varied extremely, ranging from $6083 to $24,246, with the annual cost per patient ranging from $.65 to $7.74. It was noted in this study that annual per-patient costs were lowest in the sites that used an automated data-entry interface. The main conclusion reached from this study was that ease of registry interface, data-entry times, and target population coverage affect provider participation costs. Implementation of an interface to accept and send electronic transfers of records avoid duplicate data-entry tasks and decrease provider costs.

For additional information regarding Galen Healthcare Solutions’ data exchange / interface services please contact justin.campbell@galenhealthcare.com or visit www.galenhealthcare.com/interface-service