The EHR: It’s about our patients, not technology

A message to all physicians from Robert M. Wah, MD, chair of the AMA Board of Trustees.

By — Posted March 19, 2012.

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I recently returned from the Health Information Management Systems Society meeting — HIMSS — a gathering of more than 40,000 of my closest friends and colleagues in health information technology.

One of the highlights of the meeting was the announcement of the proposed rules for stage 2 of meaningful use, which laid out the requirements for continuing to qualify for federal funding of electronic health records. The American Medical Association is closely reviewing the more than 450 pages of those proposed rules and will be suggesting improvements and changes that will help practicing physicians transition to demonstrating meaningful use of health IT in their offices and qualify for federal funds. The AMA was successful in improving the stage 1 rules, and I believe we will influence the stage 2 proposed rule set as well.

Since the inception of the EHR incentive program, the AMA has supplied input to CMS and has stressed the need for flexibility in the program requirements. We also have said that to eliminate roadblocks and encourage greater physician participation, it is important that a full evaluation of the EHR stage 1 incentive program occur before finalizing stage 2 requirements.

Another highlight of the meeting was that the AMA and AT&T announced a strategic alliance between the Amagine platform and AT&T’s Healthcare Community Online. The teaming of these two iconic groups will increase the breadth and depth of the Amagine platform that was started by the AMA to help doctors in their offices as they transition to using more health IT tools.

During the meeting I also was asked to address the Dutch “delegation” to HIMSS and speak about my global perspective on where health IT is going today and in the future. More than 300 people from the Netherlands came to HIMSS to share their experience in health IT and learn from others from around the world.

This gave me the chance to reflect on how health IT has become more a part of our medical practices over the years. I have had the opportunity to be involved in this movement at the clinic, regional, national and now, global level.

One of the primary things I have recognized across all these changes is that it is most important that we see information technology as another tool that helps doctors take better care of our patients. It is not about the technology itself, nor is health IT a technology “project”; it is about taking full advantage of these new capabilities and using them to achieve better, more effective and cost-efficient patient care. To make the most of how we use our new technology, it is very important to have the physicians’ input as development occurs. Physicians know firsthand how work gets done in the offices, clinics and hospitals, and we are always looking for better ways to improve our patients’ health.

I have not written a prescription on paper in a military facility for more than 20 years. I recall how we all disliked typing in the Rx, but after order sets and automatic detection of allergies, drug-drug interactions and duplications came about, none of us would go back to paper pads. Since those days, I had the privilege of being the associate chief information officer for the Military Health System taking care of 10 million patients in 450 clinics and 65 hospitals around the world. During my time in that position, we deployed an EHR system for the outpatient/ambulatory setting.

As part of my 23 years of service on active duty in the Navy, I was asked to be the first deputy national coordinator for health IT and set up the office we called ONC, the Office of the National Coordinator for Health IT. Working to establish a nationwide health information network with the technology and standards that go along with that, in addition to facilitating the transition to EHRs in offices and hospitals, was very exciting and rewarding.

After I left ONC, the Health Information Technology for Economic and Clinical Health Act — the HITECH Act — in 2009 made billions of dollars available to make the transition to the digital world in health care possible.

My view is that with the billions in incentives, we are moving from paper to digital records and then we are building interoperable networks and exchanges to move health information securely so that it is available where and when it will most help in taking care of patients.

After we have this digital information in secure networks and exchanges, the next logical step will be to analyze these data and develop powerful decision tools and personalize medicine. As an example, we will be able to talk to a patient with diabetes in much greater detail specific to being a 32-year-old Hispanic female with a certain family history and unique medication list by comparing other similar patients to her. It is also clear that the incentive dollars are an investment in a digital foundation for health care. This technology platform is necessary for health system reform; it is not possible to do reform on a paperbound system.

I have had the opportunity to see heath IT implemented in many countries beyond the U.S. As the chief medical officer at Computer Sciences Corp., I have examined health care in the UK, Denmark, the Netherlands, Australia and China. A common theme, as I have stated, is that the use of technology must be seen as a way to improve care for our patients and not seen as a technology program or project. It is also clear that physicians must be involved in this process from the beginning of development and through deployment of new technologies. As challenging as the technology can be, it is most important to look at the people, work flow and process changes necessary before we can take full advantage of a digital world.

Since the early days of health IT, the AMA has provided guidance and information to physicians for understanding and making the transition to technology-based practices. Physicians can take advantage of webinars that cover a wide variety of subjects ranging from specifics of payment and claim processing to step-by-step advice on adopting EHRs. Through the AMA website, there are also discussion groups on paperless practice and a tool kit for physicians moving to electronic health care.

More broadly, as we move ahead in this, the AMA will continue to work on behalf of physicians to make sure doctors are involved in all parts of the process along with providing resources to make the transition easier.

As I look to the future, I see health IT making better information available for better decisions by everyone in health care. Patients, doctors, payers, government and researchers all will make better decisions with better information that is delivered to the right place and the right time for the right patient. We can save lives and money.

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