I’m back in Boston for the second part of the Leadership Strategies for Information Technology in Health Care being run by the Harvard School of Public Health. This time we are actually on the Harvard campus which is a real buzz. Amazing how many big name facilities are within walking distance here. In my short stroll to buy some Harvard branded gifts for the family I walked past the Harvard Medical School, Brigham and Women’s Hospital, Boston Children’s Hospital, Beth Deaconess Israel and Dana Faber Cancer Centre, all on Longwood Ave within a couple of hinder metres of each other. You feel smart just walking down the street!
After the last few weeks talking about the PCEHR and telehealth in Australia it was back to hear about the meaningful use concepts. The first session was run by Dr Ashish Jha, the Associate Professor of Health Policy at the Harvard School of Public Health. The first session was an update, and started with a seminal paper from the NEJM titled “Cottage Industry to Postindustrial Care — The Revolution in Health Care Delivery” by a collection of health luminaries including Don Berwick and Brent James. It starts with the statement, “U.S. healthcare is broken” and talks about the need for transformation. He then introduced us to some very interesting work on the adoption of ehealth in the USA. Despite the rhetoric, it’s still struggling, with comprehensive EHR adoption sitting at 10.1% in ambulatory care and 3.6% in hospitals. He even gave us a glimpse of data being published that day in the Annals of Internal Medicine on Health Information Exchange Organisations or RHIOs as they used to be known, with amazingly low adoption, none meeting the expert panel criteria of comprehensive RHIO, and only 3% of hospitals and 0.9% of ambulatory practices meeting stage 1 meaningful use. There is lots of room for improvement, and a fascinating discussion across the room of why. Change management and training came up many times, and the 2 Australians and several Canadians in the room had their views.
He was followed by Dr Thomas Sequist from Harvard Vanguard on Strategies for Improving Ambulatory Care Using an EHR. He discussed the need for effective clinical decision support tools that drive behaviour of clinicians and patients. Good discussion of whether the PHR which at his facility has a 30% adoption by the patients may be the right tool for delivering this. He discussed how they used their EHR to drive colorectal cancer screening, diabetes management and chronic kidney disease patients. Combined use of innovative technology and direct mail concepts. The topic of adoption came up, and I pointed to the work of our own Dr Chris Pearce on the role of the computer in primary care practice. Seems we are ahead of the pack in a lot of things.
In the afternoon Dr Peter Almenoff from the Veteran’s Affairs Administration spoke on the utilisation of large data bases to improve quality of care and efficiency. The VA with now decades of data from their EHR system have been able to drive some amazing progress is improving both outcomes and process measures by leveraging its information assets. Lots of graphs and statistical talk, but basically with their dashboard they can drill down to who is practicing outside the norm, and work on finding out why.
The final session for the day was by Dr Christopher Roy from Brigham and Women’s on IT for Tracking Critical Labs. Again the Aussies get a mention, with Professor Johanna Westbrook’s work coming up for special mention. Some very interesting statistics, 41% of patients discharged from hospital had results pending on discharge, and 48% of those results were abnormal, with 9% being deemed actionable by their physician. 70% of hospitalists and 46% of primary care providers were unaware of these potentially actionable results, 25% of hospitalists and 46% of PCP were unaware the test were even ordered!
Another fascinating day with some of the luminaries of ehealth. Things are moving slowly worldwide, but the US guys have been leveraging meaningful use to great effect.