IT could be key to making health care reform successful

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However, switch from paper-based system won’t be easy

Editor’s Note: PricewaterhouseCoopers is conducting a series of five seminars during October and November about health care reform. This is the third in the series covered by Amy Gillentine. The series will continue through Nov. 27.
Health information technology could be the silver bullet for health care reform — saving money and improving both efficiency and safety.
But there is a lot of work to be done as the industry switches from the paper-based system so entrenched in hospitals and physicians’ offices to a national connection — in which electronic health records can be sent from doctor to hospital to insurance provider, doctors can prescribe medicine electronically and prevent drug interactions with the click of a button, and data is used to continually update procedures and decrease infections, manage illness and prevent disease.
Those were the issues explored during the third of the PricewaterhouseCooper’s five-series report about aspects of health care reform.
Given a shot in the arm by the American Recovery and Reinvestment Act, doctors and hospitals are scrambling to create networks and move to digital record keeping and prescribing.
The stimulus act provided $36 billion for electronic health records, $10 billion to pay for research at the National Institutes of Health for electronic data gathering and $1 billion to conduct comparative effectiveness studies.
“That’s the ‘carrot’ approach,” said Daniel Garrett, principal and health industries technology practice leader at PricewaterhouseCoopers. “But the government also has the ‘stick’: the industry has until 2015 to make serious inroads to health IT or face stiff fines and penalties.”
It isn’t enough to install electronic record keeping at hospitals and doctor’s offices, connecting with insurance providers and pharmaceutical companies. The legislation also requires secondary data-gathering that can — and should — be used to improve the quality of care. Sharing the secondary data with other providers and hospitals is an important step, Garrett said.
“The objective is the ability to both predict and manage outcomes,” he said. “And hospitals who use records this way can get bonuses up to $2 million, and doctors who use it well can get $44,000 in bonuses.”
At some point, technology will provide the opportunity for quality monitoring and demographic, financial and claims data, said Paul Verroneau, principal and leader of PricewaterhouseCoopers’ U.S. Healthcare Payer Practice.
“Then they can expand into use of primary data to gain a better clinical picture,” he said. “The issue is going to be to make the patient the center of IT in the innate details. Those will be the successful systems.”
But despite the massive amount of federal dollars pouring into projects — which experts say is fueling a rapid movement toward more information technology and digital record keeping — many providers are left with little guidance about how to implement technology effectively in their practices and hospital systems.
“There are key issues — a ‘so what do we do’ kind of reflection,” Garrett said. “Providers want to know about policy changes and how they affect innovation. How will the dissemination affect their organization? And how to adopt a program consistently to ensure it’s compatible with the other systems?”
The other big question: who’s going to pay for it? Doctors and hospitals are going to be required to be virtually connected, a further step toward creating a medical home for patients.
“(Doctors) are not employed at a hospital, but they do most of their work there, so they have to have this connection,” Garrett said. “But the costs can still be very, very high. And how to you get a sustainable measure of your return on that investment? These are pretty serious issues still to be resolved by agencies or laws.”
Health IT is on “a journey,” he said. And critical medical outcomes can be associated with it: comparative effectiveness of treatments, value-based purchasing of medicines, new delivery models for medicine and new prevention methods.
There is already a movement toward this goal: The Centers for Medicare and Medicaid Service has created Innovation Centers that use medical information technology, showing promise.
“There is a lot of promise in IT,” Garrett said. “But there is a huge gap between where we now are and where we need to go.”