The Great Divide: Some Closing Thoughts on HIMSS14

Walking the halls of the Orlando Convention Center at HIMSS14 this past week, I was aware of a great divide.

As one approached the vendor booths, information systems in healthcare were portrayed as successful and benefit-laden. As one walked the aisles with hands-on providers, those same systems were seen as increasingly expensive, disruptive and barren.

Add to that, concerns about the labyrinthine and costly governmental regulations that overlay the systems themselves, and it’s easy to see why providers and vendors weren’t always singing from the same hymnal.

Many of my physician peers are buckling under the cost and complexity of ICD-10 requirements, a burden detailed in a recent AMA study. Others are overwhelmed by the resources required to prove and attest to Meaningful Use, a feeling captured in the post-HIMSS observations of Deloitte:

“Changing workflows and driving adoption of EHRs is difficult and time-consuming enough, but the additional resources needed to follow the rules, apply interpretation to an individual organization environment, track vendors' certification progress, validate reports, and pull together documentation – all above and beyond efforts to improve care delivery – are a significant investment.”

One physician I spoke with shared that his group would no longer participate in Medicare — a decision that likely says as much about current reimbursement rates as it does about the internal resources and IT requirements for participating in the program.

Alas, opting out isn’t a viable solution for most. Adapting to — and adopting — information technology is, for all intents, a prerequisite for the provision of care in the US. Witness the news from Massachusetts where the demonstration of proficiency and meaningful use may become a requirement for medical licensure.

Nor should we hold out hope that regulation (and its associated costs) will lessen. Although CMS signaled some flexibility on hardship exemptions for Meaningful Use, the October ICD-10 deadline remains firmly in place.

HIT is helping “increase efficiency and save money and improve quality of care,” definitively stated Former Secretary of State and Senator Hillary Clinton in her address to attendees.

No one would take exception that this is what we want from our IT investment. But there were careful and reasonable people at HIMSS who would simply counter that we have not yet achieved these goals. 

Don’t mistake my observation of this divide as pessimism about where we are heading. Success stories were plentiful at HIMSS.

For example, Dr. Robert Lorentz, in a presentation on Benchmarking Clinical Documentation Integrity at the Cleveland Clinic, described how technology and data analysis, combined with the use of normalized CMI (case mix index) to adjust for illness severity, resulted in the capture of millions of dollars in charges previously left on the table because of inadequate documentation.

That’s real ROI that grabs one’s attention.

Enhanced revenue capture. Lower costs. Better data. Improved outcomes. These are the metrics that matter most. More successes against all of these metrics are ultimately necessary to close the divide between the promises of technology—and the vendors who create and sell it — and the practical daily realities of the providers who must implement and use it.

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