Before consumers and clinicians can reap the rewards of putting healthcare data in the cloud, that data has to be useable, accessible and modernized to fit into a cloud-ready world. These examples, one from the public sector and one from the private, explain how different healthcare providers on opposite coasts are optimizing their data for the cloud.
California clinic outsources IT
Surgery Center Partners administers 17 surgical clinics in Palo Alto, CA, and is about to shift its IT from individual offices to a managed hosting facility in Minnesota. Sue Teodecki, the director of logistics and informatics, said she can't make it happen fast enough.
"We have centers all over the place, and servers in every one of them," she said.
Each office runs its own separate software applications for tasks such as billing and scheduling. Teodecki's office handles all the financial and administrative details, which include collecting from insurers and paying doctors and staff. Providing IT support for all the different offices was a real headache, she said, and asking medical staff to participate in IT-related matters was a waste of everyone's time.
"You have to get the end users -- who are clinical people -- to do technical things" that they absolutely hated, said Teodecki, and IT resources were being wasted with help desk calls.
"I mean, you tell a nurse she has to barcode everything…"
Teodecki wanted all the clinics to be using electronic health records (EHRs), and she decided the easiest way to start this process was to take IT operations out of the local offices. Teodecki set up a pilot system for one clinic, making it 100% paperless and hosting operations at Michigan-based hosting provider Secure-24. She used off-the-shelf EHR products from companies like Provation and SourceMedical to create a system that handles every part of the clinic's day-to-day operations.
In this system, nurses and technicians enter details about each case, doctors enter clinical notes, and the information is presented systematically, said Teodecki. From the staff's point of view, all they need is a working Internet connection and familiarity with data entry, and the data is "in the cloud" delivered through Secure-24's hosted operation.
"The doctors love it. If we told them we were taking it out they'd go crazy ," said Teodecki. The doctors like having access from anywhere they have Internet, she said, and the clinical staff is relieved to have less to do and keep track of. Teodecki said that her success is mainly due to the quick maturation of EHR technologies and her trust in outsourced hosting, which is in her eyes a vast improvement over trusting doctors with servers.
The doctors love it. If we told them we were taking it out they'd go crazy.
Sue Teodecki, director of logistics and informatics at Surgery Center Partners, on the new EHR system
Some early adopters of EHRs have struggled due to the lack of standards and features. Teodecki said she wouldn't have tried using them a few years ago; however, she said the pilot has been a smash hit and she is ready to start rolling out the new system to all the clinics.
Her next step is digital document management, which involves scanning and incorporating existing paper records into IT operations and settling down to examine how the new data can start improving care.
Surgery Center Partners' quality assurance person is excited about having useful analytical data to find out what's working and what's not, Teodecki said. Analysis such as this is standard in almost every industry but universally lacking in healthcare.
She added that the economics make sense.
"The [return on investment] the first year is break-even. By year three, it's projected to save us $50,000, and that's a very loose estimate," said Teodecki, and that doesn't include potential ancillary savings from the move. That's a phenomenal projection for an IT revamp, she added.
Maine HealthInfoNet centralizes patient records
On a larger scale, entire states are feeling out similar projects. Devore Culver is executive director of Maine's HealthInfoNet, the largest statewide electronic health information exchange (HIE) in the United States.
Development started with a feasibility study in 2004, and the project opened in July of 2009. HealthInfoNet ties together the EHRs of all of Maine's medical providers, essentially storing all of a patient's records in one place for easy access. It's a concept that Culver thinks will eventually dominate the country. Vermont and Delaware also have HIEs like Maine's, and it's no coincidence that all three states share a common denominator -- a relatively small population.
Maine is a small state with a general population of a million plus.
"That's a nice size for a health records program," Culver said.
There is one thing that is very true about consumers -- they don't want to participate…The ones who [do] participate are the ones who are sick, because there's an immediate return on investment.
Devore Culver, executive director of HealthInfoNet, on the reluctance to accept healthcare informatics reform
It was a manageable project from an informatics perspective, he said. He added that it made a lot of sense for healthcare to breakdown around geopolitical boundaries, as there is a different set of patient privacy and healthcare records laws and regulations for every state.
Culver said that his project was aimed at freeing records from insurance companies, as patients shifted companies so quickly that records were being lost.
"You're with Cigna this year, you're with Aetna next year…you lose the connectivity," he said, and unless you see the same doctor, providers can't keep up.
But insurance providers aren't very interested in health information reform, Culver said. They already have their business processes sorted out, and they don't see the financial benefit in helping doctors receive better access to clinical records.
"They've been lukewarm," he said. "Conceptually they're very supportive, but financially, they've done very little. They say that just because you present data, clinicians will not change their practice, and the financial incentives aren't there."
The idea the insurance providers have is just plain wrong, Culver said, and HealthInfoNet would prove the value in clinical data very quickly. On the flip side, doctors were very worried that actuaries would use clinical data to throttle back care options, but Culver doesn't believe that will happen, either. He said that, in any case, doctors and patients have final say over their records.
What's slowing down healthcare informatics reform?
There are more severe difficulties in other major areas for healthcare informatics reform: information standards and patient awareness.
"[Standards] are a horribly difficult issue," Culver said, another reason that a small state like Maine, with a population of 1.3 million, can start a HIE. California, for example, has 30 times the population of Maine and a correspondingly larger Gordian Knot of hospital and healthcare systems with widely divergent information systems.
"We put a lot of time and money -- where standards exist -- to standardize content." Culver said.
At present, Culver believes standards aren't as easily solvable in other parts of the country. Still, he suspects that the federal government, which is making a strong push for EHRs and information exchanges such as Maine's, will eventually support emerging standards for health records overall. He thinks the shift is inevitable, and believes that the country will see notable changes in how the healthcare system as a whole handles its medical information in five years to seven years.
By that point, he said, the patients might have more awareness and interest in their healthcare data; right now it's practically zero. Like many others, Culver thinks the minimal involvement patients have with the management and administration of their healthcare also retards progress. Consumers are perfectly happy to put blind faith in healthcare providers in a way they would never stand for if they were, for instance, taking out a car loan or buying a house.
Consequently, because they know so little about how their records are handled and how healthcare is actually run, they simply don't see the enormity of the waste and clumsy antiquated business methods. No bank today could possibly survive if it still relied on paper filing systems for every account holder, yet it's estimated that the majority of health providers do just that.
"There is one thing that is very true about consumers -- they don't want to participate until they are sick," Culver said. Patients have been trained not to worry about either the financial end or the process end of healthcare, instead placing all their faith in doctors. Their costs are hidden by insurance, and that's very hard to change, said Culver, until patients need a more streamlined system. "The ones who participate are the ones who are sick, because there's an immediate return on investment."
"I don't think PHRs make a damn bit of difference -- yet," he said. "You gotta crawl before you can walk."
Whatever the level of patients' enthusiasm, Culver's politically sensitive efforts in the public sphere and Teodecki's smash hit of a reform project for her own small healthcare system prove that change is afoot.
Carl Brooks is the Technology Writer for SearchCloudComputing.com. Contact him at firstname.lastname@example.org.