Ray Scott speaking at the Clinton School of Public Service

State picks up pace in HIT adoption

When Baptist Health’s North Little Rock campus goes live with its Epic health information technology software next February 26, the entire system will be online. There will be no paper charts to read and no prescriptions written using ink pens.

The Little Rock campus will follow in September as part of a planned rollout of Baptist’s entire system, a process that is costing $70 million for the core technology alone. But there’s still a long way to go.

“I figure I’ve got another 10 years’ worth of work,” said Chief Information Officer David House.

Baptist Health’s adoption of health information technology mirrors the work done by providers across the state that are working to improve care, take advantage of $500 million in stimulus spending in Arkansas through the federal HITECH Act, and be able to certify “meaningful use” of the technology by 2015, when Medicare reimbursements may be reduced for those lagging behind.

Ray Scott, a former director of the Department of Human Services who was appointed in May 2010 by Gov. Mike Beebe as Arkansas’ state coordinator for health information technology, is leading the statewide effort.

Among the state’s HIT efforts has been the creation of the State Health Alliance for Records Exchange, whose purpose is to facilitate the movement of health information in accordance with nationally recognized standards. SHARE’s first phase, which should be completed by the end of the year, will make it easier for Arkansas providers to e-prescribe, exchange structured lab results, and exchange clinical care summaries.

Speaking to the Clinton School of Public Service in September, Scott said SHARE’s second phase will allow providers to access and share patient information as well as practice “syndromic surveillance” by, for example, monitoring how many prescriptions have been written statewide for a certain antibiotic.

During his speech, Scott described Arkansas’ current healthcare system as consisting of “silos of uncoordinated care” that fail to communicate patient data with each other.

“As you move across the healthcare system, and you go from threshold to threshold, I just hate to tell you this, but, trust me, your information does not follow,” he said.

Scott cited a study by the Society of Actuaries showing that avoidable medical errors caused more than 2,500 deaths and cost the U.S. economy $19.5 billion in 2008. He cited a Rand Corporation study showing that the country could save $80 billion a year with better use of HIT.

Scott said medical providers won’t have a choice when it comes to adopting health information technology. Consumers will demand it. So will payers, including the federal government and insurance providers, who will pay for outcomes rather than procedures. In fact, under 2010‘s healthcare reform law, starting next year acute care hospitals, whose readmission rates are too high for congestive heart failures, heart attacks and pneumonia, will see smaller Medicare payments.

Scott said that “doing this with some fax machines and six-inch thick paper files ain’t going to get it. And what’s going to happen – what’s already happening – is the payers, both public payers, which means Medicaid and Medicare, and private payers are already beginning to insist, in fact if not demand, that providers move to adopt and use electronic health record technology in a meaningful way.”

To adopt health information technology, physicians are eligible for up to $64,000 and hospitals $2 million in Centers for Medicare and Medicaid Services incentive payments through the federal HITECH Act. Scott said the HITECH Act could provide $500 million in stimulus in Arkansas.

But there are difficulties in adopting the technology. One is a lack of broadband access in parts of Arkansas. Another is the lack of employees prepared to move into the health information technology field. According to Scott, there aren’t enough trained Arkansans ready to take the jobs that soon will be available. Meanwhile, the jobs aren’t good enough to attract trained workers from other states. That’s why he said the state is adopting what he joked was a “high-tech redneck strategy” – training workers here at home. National Park Community College in Hot Springs has received a $1.5 million grant to train health information technology employees in the field.

The most important stumbling block is among physicians themselves. Federal grants are paying for regional extension centers headed by the Arkansas Foundation for Medical Care that are providing health and support, but some physicians are still reluctant to embrace the technology. “There’s a generation gap here,” he said. “Younger docs think we’re not moving near fast enough. The older docs wish it would go away.”

Scott recounted a conversation he had with his own family practitioner, who told him she didn’t use computers and hand-wrote the notes on his charts. Scott said he told her, “Well, I really hate to hear that because your handwritten notes aren’t worth a damn to my cardiologist.” He said she replied, “I get it. I just can’t change.”

Baptist’s House said that most medical providers recognize the inevitability of health information technology, even if they don’t relish the idea. He compared healthcare’s situation to the post office, which has been forced to respond, and not always successfully, to the changes caused by email. He pointed out that banking, retail and other sectors long ago adopted high-tech communications technology.

“I think most people in their heart of hearts, even though they may not like the change, they recognize that it’s here, and quite frankly I think most people recognize it’s probably overdue,” he said.

Scott told the crowd at the Clinton Center that two cardiologists had told him that the process had taken twice as long as they expected and cost twice as much, but that they wouldn’t go back even if all the money they had spent could be refunded.

Still, for doctors who have practiced medicine a certain way for decades and now are being forced to change while still providing patient care, it can be a daunting task – one he is trying to make a little easier.

“I respect the fact that it’s an individual decision every clinician has to make – both a clinical and a business decision,” he said. “I think our job is to try to give them every compelling reason we can to say yes and do it and remove whatever barriers and obstacles we can.”

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