So when it comes to heathcare IT, what works?

[rninformatics, DNP, RN]

In President Obama's recently passed stimulus package - some 19 billion dollars as been allocated towards healthcare IT.

Despite the support of our government we all know of horror stories about failed clinical system implementations, clinicians working with poorly designed systems, cumbersome to navigate screens, little decision support and "too many clicks"

So what does work related to healthcare information systems that you are using or have used in the past???

Speak up .............and enjoy the article below from iHealthBeat below.

From Thursday, Friday 19, 2009 iHealthBeat

When It Comes to Health Care IT, What Works?

by Kate Ackerman, iHealthBeat Editor

During his inaugural address last month, President Obama said, "The question we ask today is not whether our government is too big or too small, but whether it works ... Where the answer is yes, we intend to move forward. Where the answer is no, programs will end."

That statement triggered, in part, a briefing by the Center for Health Transformation, called "Healthcare That Works: Answering President Obama's Challenge of Finding What Works."

Health IT made the group's list of "health care that works." The group states, "To do anything to transform health -- from paying from outcomes to comparative effectiveness to avoiding medical errors -- health IT is absolutely essential. No other industry is as antiquated as health care. [Electronic health records] and other technologies are the only tools that simultaneously reduce costs while improving care."

Federal lawmakers seem to agree. During the presidential campaign, Obama pledged to spend $50 billion over five years to support health IT and in a speech pushing his economic stimulus plan last month, Obama called for all U.S. residents to have EHRs within five years.

Obama said, "To improve the quality of our health care while lowering its costs, we will make the immediate investments necessary to ensure that within five years, all of America's medical records are computerized." He added, "This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests. But it won't just save billions of dollars and thousands of jobs, it will save lives by reducing the deadly but preventable medical errors that pervade our health care system."

At the Center for Health Transformation briefing, former Speaker of the House Newt Gingrich, who founded the center, said, "I am very supportive of what the administration is trying to do in general in making the investment in health information technology and in recognizing that getting an electronic health record for every American and creating interoperability ultimately is a key to having the kind of health system we want to have."

Meanwhile, the economic stimulus package recently signed by President Obama includes about $19 billion for health IT.

Despite the support on Capitol Hill, studies routinely identify flaws in health IT systems and health care experts often warn that health IT is not the silver bullet.

So when it comes to health IT, what works?

Physician Buy-In

David Merritt, project director at the Center for Health Transformation, said that "physician buy-in and ensuring that it's a collaborative process between the providers who are actually going to use the technology ... and the executive leadership of the institution" are the keys to ensuring that health IT works.

Merritt cited the failure of a health IT implementation project at Cedars-Sinai Medical Center in Los Angeles a few years ago as an example of what happens when physician buy-in is missing. He said, "That process was anything but collaborative ... it was so cumbersome and it rolled out so poorly that the project collapsed under its own weight."

Merritt said, "If institutions do it right ... they always try to bring along physician leaders to guide and to try to teach the other users how to do it right." He added, "Some do it slowly and others do it flip of the switch ... but however they go about it, getting that physician buy-in is absolutely critical and if they don't have it, that can certainly put the entire initiative in peril."

More Than Automation

A National Research Council report released last month found that Health IT efforts often fall short of achieving the health care delivery goals envisioned by the Institute of Medicine.

William Stead -- lead author of the report and associate vice chancellor for strategy/transformation and director of the Informatics Center at Vanderbilt University Medical Center -- said that since the late 1990s, people have assumed that we could achieve high-quality care at low costs "if we just deployed today's health care IT. And our answer was, if you do that, you won't get there." He added, "It doesn't mean that you cannot make things some degree better."

The study, which reviewed health IT systems at eight health care facilities, found that:

Patient records are fragmented across computer and paper;

Clinical user interface mimics the paper work process without much attention to human factors and safety design;

Health IT systems often are used to document after the fact and often for regulatory or legal reasons, rather than patient care; and

Systems provided little support for evidence-based medicine computer decision support.

Stead said, "I think one of the fundamental conclusions we had was that the approaches taken by the health care industry to using IT don't really scale up to the size of the problem."

He said, "If you look at other industries that have been successful in using IT, you'll discover that they do some automation, they do some connectivity, they do some decision support and they do some data mining, and, in fact, they tend to have a fairly equal balance amongst those four things." Stead added, "In health care, it is probably 90% automation, maybe 6% connectivity, maybe 3% decision support and 1% data mining. So one of our points was health care needs to rebalance how it uses IT."

"If you think about it, systems that really automate workflow tend to cast workflow in concrete. We're talking about supporting a rapidly changing health care system," Stead said, adding, "We're not trying to say don't use health IT, but we are saying that what they really should do is manage it as a clinical improvement effort, not as an IT deployment effort."

[SuesquatchRN, BSN, RN]

He said, "If you look at other industries that have been successful in using IT, you'll discover that they do some automation, they do some connectivity, they do some decision support and they do some data mining, and, in fact, they tend to have a fairly equal balance amongst those four things." Stead added, "In health care, it is probably 90% automation, maybe 6% connectivity, maybe 3% decision support and 1% data mining. So one of our points was health care needs to rebalance how it uses IT."

I work with one of the most badly designed, non-intuitive systems on the planet. I now have three different layers that don't interface smoothly and these changes and various iterations of the same system should be utterly transparent to the user.

I am the only person in the facility who has figured out how to go data mining in the files - which I love, as does management, because health care is the least business-savvy industry in which I have ever had a job. I have never met such clueless people, business-wise, as clinicians. I spent the day arguing with our med director via email about why he should have to sign in more than oce a day. Then he wanted to know why the PA's needed to use fingerprint authentication AND passwords. These guys'd never get away with these shenanigans if management didn't think the physicians walk on water.

When we rolled out the last iteration we KNEW from the specs that the hardware was inadequate but had to wait for the nurses to almost revolt so we could justify the expenditure to the board.

And the system stinks.

I'm rambling. I find it frsutrating.

[AshleyWallace]

I am new to the IT and informatics scene, but it does seem to me that healthcare IT is inconsistent....and that going from paper to technology and back and forth is a waste of precious time, and time that could be spent on patient care. There must be an easier solution. I believe this is just a transition period as we are moving away from a paperless world. It's just the dangers of technology on privacy and confidentiality are still a little scary to me. Technology is only growing bigger and better....and we must find a way to use it efficiently and safely.

[jmgrn65, RN]

We currently use CareCast for charting etc. But we use Eclipsys for ICU charting, and PICIS for OR, it is ridiculous. We are looking at Epic and Cerner, to be our enterprise system.

[SuesquatchRN, BSN, RN]

It's just the dangers of technology on privacy and confidentiality are still a little scary to me. Technology is only growing bigger and better....and we must find a way to use it efficiently and safely.

One of the biggest problems are the laws and FINES for breaches in the system. It costs a LOT to institute and maintain the far-reaching requirements of securing data under HIPAA, some credit card laws, and other statutes whose numbers and acronyms I can't recall. We're a rural CAH and out budget is solely grant-driven. NYS recently mandated pretty extensive new safety features but provided no money to effect the changes.

A HUGE problem we have is we simply can't run a parallel test system because we can't afford a second license for the AS/400. So ALL CHANGES GO LIVE. All training is done in a live sytem on live data.

Good luck. I have nurses who literally don't know that you click the x in the upper right to close the browser.

[WDWpixieRN, RN]

I am the only person in the facility who has figured out how to go data mining in the files - which I love, as does management, because health care is the least business-savvy industry in which I have ever had a job. I have never met such clueless people, business-wise, as clinicians. I spent the day arguing with our med director via email about why he should have to sign in more than oce a day. Then he wanted to know why the PA's needed to use fingerprint authentication AND passwords. These guys'd never get away with these shenanigans if management didn't think the physicians walk on water.

I'm heading back in to the healthcare IT arena after spending 6+ years in the financial services industry IT world. It's amazing to me that there are not the same safeguards/rules/laws that govern healthcare yet that we had to deal with.

But then again, these are probably some of the same people who shred some documents in the hospital, while throwing numerous others in the trash can and are feeling like they are following HIPAA laws.