Problem: Immature, Insecure, Expensive Technologies

There a number of problems with today’s HIT tools, but each has a solution.

Immature Technologies

Most HIT systems in use today are immature technologies that need time to evolve.
  • Shortcomings of EHRs and CPOEs may be, for example, that are:
    • Too slow for ICUs, ERs, and even busy practices
    • Not tailored enough to a provider’s specific needs and thus need extensive modifications to accommodate workflows
    • Poorly designed and error prone
    • Incompatible with other IT systems being used.
  • Shortcomings of decision tools (e.g., computerized practice guidelines and clinical pathways) may be that they;
    • Do not respond well to unexpected changes in a patient’s condition
    • Are better handling standard conditions than unusual or unpredictable ones
    • Fail to ensure variance and outcomes are properly recorded, audited and acted upon
    • Are not practical for use in actual clinical settings.

Insecure Technologies

Consumers have multiple concerns about computerizing their healthcare data, including:
  • Computer hackers could break into their medical records and expose sensitive personal data
  • Marketers could use their personal healthcare data to target patients with specific diseases
  • Information from medical records could used to disqualify people with health problems from obtaining loans and jobs.

Expensive Technologies

HIT systems can be very expensive. For example, CPOEs have ranged from $3 million to $10 million, depending on hospital size and level of existing IT infrastructure. Physician in small practices spent an average of about $44,000 per full-time equivalent provider to implement an EHR system and about $8,500 per provider to maintain the system; and the average cost of purchasing and implementing an EHR system in a group practice is about $32,600 per FTE physician, with monthly maintenance costs of $1,500 per FTE physician. The total cost for building a national health information network is estimated to be $156 billion in capital investment in the next five years plus $48 billion in annual operating costs.

Solution: Rational Incentive Programs, Patient Life-Cycle Wellness System, and Core-Competence IT Vendors Consortiums

Rational Incentive Programs

Incentive programs address the high cost of HIT systems by giving providers financial incentives to purchase the systems, such as through grants. These incentives may come from payers, who stand to benefit from improved care quality (e.g., reduction in medical costs through prevention of adverse drug events, readmissions, delivery of more cost-effective care, etc.) and access to more comprehensive patient data and clinical outcomes. Other funders may include government agencies and philanthropic organizations.

Deploying the Patient Life-Cycle Wellness System

Another way to solve the problems of immature, insecure, and expensive technologies is to deploy the Patient Life-Cycle Wellness System described earlier. This complete, adaptable, continually maturing, exceptionally secure, and very economical system brings the future here today.

Advanced Technologies

The Patient Life-Cycle Wellness System blueprint lays out an integrated system of software tools that continually evolves and matures. It provides a full range of capabilities that not only improves care outcomes the creation and use of comprehensive, cross-disciplinary scientific knowledgebases and decision-support tools, but also streamlines workflows for greater operational efficiency, supports collaboration between all stakeholders, and constantly looks for signs of bioterrorism, epidemics, and dangerous medications.

The flexibility and adaptability of the system also enables it to accommodate any information standards, data sets, data dictionaries (for translating and coordinating data definitions across stakeholder groups), communications protocols, and healthcare applications. The system’s decision-support applications, furthermore, can be customized to clinicians’ preferences to enhance their usability and acceptance.

Secure Technologies

The Patient Life-Cycle Wellness System goes beyond other technologies to make certain sensitive healthcare data is protected. In addition to using current-day HIPPA compliant methods and assuring that the patients have final say about who gets to view their health data, the system provides the following:
  • MultiCryption™. MultiCryption is a unique process that splits patient data into multiple files, each with its own encryption key. One file contains patient identification data (the ID file) and the others contain the actual healthcare data (the data files). When submitting data to for research, the ID file is not be sent. When submitting data to an authorized provider requesting an EHR, the data and ID files can be sent separately, and the encryption keys can be send apart from the data files and stored in a different location. This process is unique and exceeds current HIPPA compliance in that it provides the only encryption method that is forever immune to brute force attacks of files being transported, and which provides another level of protection against hacking by “insiders.”
  • Reliable Enrollment. Instead of authenticating the healthcare provider's computer or relying only on PINs, it authenticates the provider himself or herself. The identity credential consists of a smart card or other device such as a USB token that is issued during a face-to-face enrollment meeting during which biometric data is recorded. Authenticated providers insert the card into a card reader attached to their computers (or USB token into USB connector) in order to gain access to confidential patient data

Affordable Technologies

The Patient Life-Cycle Wellness System consists of integrated software tools that are flexible enough to work with existing HIT tools end users may have. It also uses computerized health agents (CHAs) that employ a very simple and efficient secure technology for information access and exchange that requires no infrastructural buildup, no costly centralized architectures, no hassles with VPNs, and no concern about scalability limitations. These things help minimize HIT purchasing, deployments operating costs and expenses.

Core-Competence HIT Vendors Consortiums

Since no single HIT vendor can have exceptional competence in all healthcare technologies, it makes good sense for vendors to form collaborate consortiums to offer a compete system comprised of each members core-competencies. Including small IT business in the consortiums brings healthcare stakeholders greater value because they:
  • Help reign in costs due to their lower overhead
  • Increase responsiveness to stakeholder needs since there is a wider selection of HIT tools to accommodate particular stakeholder requirements and
  • Promotes innovative solutions since small companies tend to be more agile and responsive due to their reduced management bureaucracy.

Problem: Addressing the Needs of Smaller Providers

Within the next five years, large providers, such as hospitals, are expected to have the most clinical functionalities in their HIT systems, followed by smaller hospitals, and then large, medium, and small office practices, home health agencies, and skilled nursing facilities. These inequities will impair the continuity of care. Furthermore, while small practices use EHRs for common tasks such as prescribing, record viewing, within-practice messaging, and billing, few used them for quality improvement, performance reporting, or patient–provider communication.

Solution: Offer Affordable and Useable Technologies for Smaller Providers

As discussed above, making HIT systems more affordable would help solve the problem. In addition, the systems should be tailored to the particular needs of the providers and their specialties. The Patient Life-Cycle Wellness System, therefore, should include tools developed by Core-Competence HIT Vendors Consortiums.

Next: Problems Relating to Provider Motivation and How to Solve Them

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