IT used to be a little-thought-of, back office operation in healthcare, but now it is being looked at to solve some of healthcare's biggest problems, including waste.
Christina Galanis is president and CEO of HealthlinkNY, a regional health information exchange. HealthlinkNY is one of the state's largest HIEs, whose participants include 31 hospitals, 442 clinical practices, 23 behavioral health entities and six federally qualified health centers. Ms. Galanis examines where healthcare toils the most when it comes to waste and offers insight into how IT can help cut down on excess time, money and resources.
Please note responses have been lightly edited for clarity and concision.
Question: What do you think are the biggest areas of waste in hospitals and health systems?
Christina Galanis: Clinicians waste a tremendous amount of time searching for information. EHRs help, but think of the typical emergency department. Clinicians may have to log on to five different systems with five different passwords in order to search for patient records. Even with EHRs, the ED intake coordinator still has to ask the patient for basic information that has been recorded dozens, maybe hundreds, of times at other medical encounters. This fall, I landed in an emergency room with chest pains. I was anxious and I was scared, and there was a nurse asking me if I am allergic to latex! How long did the intake process delay my treatment, I wondered?
The other big waste is duplicate testing. A Brookings Institution study published this year in the Journal of the American Medical Informatics Association showed that in one emergency department, exchanging data via a health information exchange much like ours reduced duplicate laboratory tests by 52 percent and [duplicate] radiology examinations by 36 percent. Not only does this lower cost — a great concern as hospitals move from fee-for-service to value-based payment models — it also reduces a patient's needless exposure to radiation and discomfort during lab tests.
Q: How can healthcare leaders utilize IT to address these issues?
CG: Hospitals need to exchange data with primary care providers and be able to look up patient records outside of the institution. ED clinicians need to access patient histories, and they should be able to send a message or question within the system to primary care providers or specialists, get a message back and receive an email or text alert that a message is waiting. By connecting to the HealthlinkNY health information exchange, your hospital can send an alert to PCPs that their patients have come to the ED or been admitted to the hospital. Many times the PCP has no idea the patient has been hospitalized. If the physician doesn't know, the patient may end up being readmitted, which has serious financial repercussions for the institution.
So, when the patient goes to the ED, the hospital should be able to look up the patient's records, print them out and have the intake coordinator validate them with the patient. This can save your department a great deal of time. More importantly, if the patient is unconscious or incoherent, or can't remember his or her medications, it can save a life.
Q: What do you think will be the most important IT and waste reduction initiatives to pursue in 2016?
CG: Connecting hospitals and public health departments to an HIE should be the highest priority. The beauty of the regional HIEs in New York state is that they are vendor agnostic. So if a hospital uses one EHR and a radiology practice uses another, the HIE allows them to exchange data. For example, hospitalists can use the HealthlinkNY portal's PACs viewer to look at images and resize them without downloading them, and remain HIPAA compliant throughout the process. Hospitalists can send notes with questions to the radiologists, and again remain HIPAA compliant. That's an amazing time saver. When you can't email other clinicians because of HIPAA, you end up playing telephone tag. It's a huge time waster. So, anything that speeds treatment, information and decisions is crucially important to controlling length of stay as well as improving patient satisfaction.
Q: IT projects can be expensive and considered wasteful themselves. How can leaders ensure these initiatives pay off in the long run?
CG: Leaders have to make sure people actually use them [HIEs]. Already 84 percent of the hospitals in New York state can connect to the Statewide Health Information Network of New York. Unfortunately, many hospitals don't take advantage of this capability. When I went to the ER, that hospital was connected to the HealthlinkNY HIE. But the clinicians didn't know they could look up my patient record, and they didn't know how to do it when I told them they could. That's why New York state has given us money to use as incentives to get hospitals and other providers to exchange data, to teach hospital and provider staff how to use it and the value they will gain in using HealthlinkNY. A large part of HealthlinkNY's work involves training clinicians. Hospitals should make sure that patient record look up is part of the intake process. I should point out that all of this is done only with the patient's consent.
At the end of the day, data exchange can't be just an IT initiative. It has to be owned by the hospital administration and its clinical leadership. I suggest that hospitals use the frequency of patient record look up as both a performance metric and a quality metric. If you measure use, clinicians can be held accountable. Unless you exchange data with other providers, you increase the risk of medical errors, disgruntled patients and wasted resources, time and money. Hospitals can't afford to do that anymore.