The transformation from fee-for-service to value-based purchasing and accountable care is the current solution to healthcare reform, and this shift needs to be reflected in a hospital's electronic health record system and other health IT ventures, said Paul DeMuro, JD, partner at Latham & Watkins at AHIMA's 2011 EHR Summit in Chicago on Aug. 15.
Mr. DeMuro gave six areas of health IT and how the intricacies of accountable care will be poised to affect them.
1. EHRs. Many smaller health systems might not have the funds for robust EHR implementation, but regardless of the system, providers need to ask these questions to both the EHR vendors and themselves: Are requirements for meaningful use met? Does the technology do what the vendor said it will do? Has the vendor tried to carve out any of its potential liability? What happens when the vendor does not continue to support the EHR? What are the privacy and security considerations?
2. Evidence-based medicine. Patient values and expectations are now relying on the best external evidence and clinical expertise for decision-making, Mr. DeMuro said. To accommodate those expectations, he said "it's very important we live in an evidence-based medicine world" and move toward that type of evidence that looks at the risks and benefits of treatments and tests from specific scientific methods.
3. Clinical decision support systems. Many clinicians are saying CDSS is taking away from their practicing of medicine, Mr. DeMuro said. Although they might feel their diagnoses are trying to be replaced by computer input, he added the start-up time is always longer for ventures that are newer. CDSS offers alerting, reminding, critiquing, interpreting, diagnosing, assisting and suggesting of quality care, and the system falls right in line with what accountable care objectives try to achieve.
4. Computerized physician order entry. CPOE is helping hospitals deliver care and reduce redundancies and/or errors in tests and treatments. Mr. DeMuro said healthcare providers must ask if their CPOE process does what the vendor says it will do and if the clinicians using the system agree on what the process will assist in ordering and recommending.
5. E-prescribing. Similar to CPOE, e-prescribing is helping to eliminate poor handwriting errors, especially in relation to drug prescriptions, and Mr. DeMuro said healthcare organizations should also look to see if their e-prescribing process has drug alert capabilities, if clinicians ignore alerts and if the failure to use e-prescribing is a potential for liability.
6. Clinical integration. Physicians, nurses and other clinicians working together as a team create managed care considerations for any hospital looking to achieve accountable care, Mr. DeMuro said. However, due to contractual relationships and financial incentives to clinicians and hospitals, healthcare providers must try to provide managed care without crossing through fraud and abuse.
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Mr. DeMuro gave six areas of health IT and how the intricacies of accountable care will be poised to affect them.
1. EHRs. Many smaller health systems might not have the funds for robust EHR implementation, but regardless of the system, providers need to ask these questions to both the EHR vendors and themselves: Are requirements for meaningful use met? Does the technology do what the vendor said it will do? Has the vendor tried to carve out any of its potential liability? What happens when the vendor does not continue to support the EHR? What are the privacy and security considerations?
2. Evidence-based medicine. Patient values and expectations are now relying on the best external evidence and clinical expertise for decision-making, Mr. DeMuro said. To accommodate those expectations, he said "it's very important we live in an evidence-based medicine world" and move toward that type of evidence that looks at the risks and benefits of treatments and tests from specific scientific methods.
3. Clinical decision support systems. Many clinicians are saying CDSS is taking away from their practicing of medicine, Mr. DeMuro said. Although they might feel their diagnoses are trying to be replaced by computer input, he added the start-up time is always longer for ventures that are newer. CDSS offers alerting, reminding, critiquing, interpreting, diagnosing, assisting and suggesting of quality care, and the system falls right in line with what accountable care objectives try to achieve.
4. Computerized physician order entry. CPOE is helping hospitals deliver care and reduce redundancies and/or errors in tests and treatments. Mr. DeMuro said healthcare providers must ask if their CPOE process does what the vendor says it will do and if the clinicians using the system agree on what the process will assist in ordering and recommending.
5. E-prescribing. Similar to CPOE, e-prescribing is helping to eliminate poor handwriting errors, especially in relation to drug prescriptions, and Mr. DeMuro said healthcare organizations should also look to see if their e-prescribing process has drug alert capabilities, if clinicians ignore alerts and if the failure to use e-prescribing is a potential for liability.
6. Clinical integration. Physicians, nurses and other clinicians working together as a team create managed care considerations for any hospital looking to achieve accountable care, Mr. DeMuro said. However, due to contractual relationships and financial incentives to clinicians and hospitals, healthcare providers must try to provide managed care without crossing through fraud and abuse.
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