With information technology, there’s always something newer, better, faster, more expensive. For most doctors, the challenge isn’t to stay ahead of the curve; it’s just to stay somewhere on the curve while negotiating the convoluted maze of options available for their offices. Deconstructing the myriad healthcare IT choices that comprise today’s IT software and vendor offerings is hard enough. Finding ways to fund new IT while maximizing efficiency and minimizing wasted time is even trickier. But a couple of Arkansas-based organizations are working on it, via very different ends of the spectrum.
Free Consulting, Anyone?
In 2005, the census found that Arkansas was one of the least “wired” states in the nation.
The previous year, the state’s medical quality improvement organization, Arkansas Foundation for Medical Care (AFMC), had become one of four selected to be part of a federal physician office health IT pilot program called the Doctors’ Office Quality Information Technology (DOQ-IT) program. Suddenly, AFMC had money to help Arkansas healthcare facilities explore IT solutions for their offices.
“The government pays us to go out and help physicians’ offices and hospitals and home health agencies identify and assess the need they have for health IT,” explained Nancy Archer, RN, who is assistant vice president of AFMC’s Health Care Quality Improvement Program. “We help them identify what type of products might be best for them and help them implement it, since it involves more than just buying something, taking it out of the box and plugging it in.”
AFMC does not have funding to actually pay for any of the IT purchasing, but their help does save facilities money. “When you bring a consultant of any kind no matter what business you’re in, you have to find a way to fund the consultant in addition to whatever they’re coming to prepare for,” Archer said.
DOQ-IT addresses many kinds of practice types with an emphasis on small- and medium-sized Arkansas primary care practices, including those already having varying degrees of technological sophistication. Benefits of participating in this project include improving efficiency, clinical quality and safety of care provided to patients, and often, increasing profitability.
“Many sites experience increased productivity with the IT implementations, but it really depends on who you are and how you’re using the technology,” she said. Some practices choose to use just a portion of an IT system, for instance, just to order lab work and get the labs back electronically.
AFMC’s consultants concentrate on understanding exactly how a given office operates, evaluating and streamlining processes, putting considerable effort into intelligent and thorough front-end planning, and employing and adapting best practices to fit facilities’ needs. What works for one facility doesn’t necessarily work for another, so it involves a mixture of analysis and technology.
“We go through a lot of information,” she said. “We really focus on increasing the amount of thought that goes into the planning stage. We do process redesign where we go in and identify the different components that are going on in the practice currently and mapping that across to see if there are ways it could change to improve efficiency or save money.” A number of providers in the state were already well on their way, however, to implementing electronic health records and other technologies long before AFMC got involved.
Connecting people is another service AFMC helps coordinate.
The program has been extended and expanded since its conception, thanks to AFMC’s Medicare 8th Statement of Work and an ongoing partnership with the state. Most recently, a new Medicaid contract supported expanding the program to promote electronic health record adoption in any Medicaid physicians’ offices and specialty and pediatric areas that were not already being covered by the Medicare work.
Archer said DOQ-IT was initially slow to catch on, and they convinced providers one at a time to sign up. But as awareness grows, so does participation in the program. Now there are close to 300 facilities around the state that have opted in, representing more than 700 physicians, nurse practitioners and physician assistants. There’s at least one DOQ-IT participant in almost every county, Archer said, but there’s no limit on participation. That’s a good thing, too, because DOQ-IT enrollment is now a prerequisite for the Center for Medicare and Medicaid Services’ new Medicare pay-for-performance incentive program.
Opening Lines of Communication
In 2006, Arkansas was once again one of only four states chosen for a grant pursuing regional healthcare improvement using information technology, once again managed by AFMC. The Regional Quality Improvement program is a Center for Health Care Strategies funded initiative by the Robert Wood Johnson foundation to test Medicaid’s capacity to promote system-wide improvements in chronic care delivery.
It has two components. The first is working with other state healthcare stakeholder groups (insurance companies, professional associations, etc.) to identify common metrics for clinical performance measures. This would create a uniform data set by which all stakeholders could better understand healthcare delivery and cooperatively improve its effectiveness.
But the part of the RQI grant Archer is most excited about is the initial plans for a Health Information Exchange program, which would connect different healthcare providers to each other’s records and data. The grant provides funding to create a sustainable business plan for the project.
“With the Health Information Exchange,” Archer explained, “if you were a patient in Texarkana and you had been seen in another part of the state, there would be an established way to share information electronically and have access to your data and records that your physicians needed to make intelligent healthcare decisions.”
Other health IT initiatives under way by AFMC include intensive Home Health Telehealth work with Arkansas home health agencies and promotion of computer physician order entry (CPOE) and bar-coding technology for hospitals.
Getting Past the Fear
Archer said two big barriers to healthcare IT implementations exist. Getting buy-in from the people who will be transitioning to the new technology, particularly from older physicians who have been doing things a certain way all their careers, is always a challenge. “When they’ve been doing things one way for so many, many years, they’re just resistant to change.”
But the biggest barrier is still money, even when it’s available. AFMC will work with practices to develop a phased IT implementation plan as funding allows, but facilities and hospitals often are still hesitant to make the requisite investments and commit to system-wide change.
August 2007
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