Visions: Wade offers straight talk on e-medical records

Editor's note: John Wade, VP/CIO, Saint Luke's Health System of Kansas City, will be a keynote speaker at the annual Digital Healthcare Conference May 9 and 10 in Madison. He recently spoke to WTN from his Kansas City office and offered a candid assessment of the state of health information technology.

WTN: What are the key remaining barriers to wider adoption of electronic health records?

Wade: I think there are a couple. First, there is the cost of implementing them, and that applies to both the inpatient EMR and the outpatient EMR. On the outpatient EMR, I think beyond just a cost issue, is reluctance by physicians to just embrace that level of technology. Cost has got to do with a piece of it, but I think there is a general mindset still with the physicians that, “Gee, maybe I can hold off from doing this for another few years.”

WTN: What's the best way to get more physicians to actually use electronic medical records?

Wade: To me, I think it's an educational process that needs to be undertaken on a much more aggressive basis. I think organizations like HIMSS (Healthcare Information and Management Systems Society), like your own group, WTN, needs to redouble their effort to get the educational process out there, and to do it is going to be an impossible situation. So I think there is going to be a revised strategy to go on.

I know last week, there was some legislation introduced by the chairman of the CCHIT (Certification Commission for Healthcare Information Technology) Mark Leavitt, who also happens to be the CMIO of HIMSS in a different life, asking Congress to provide financial incentives for physicians. I think he's trying to address the issue of, “Gee, they hide behind the fact that it's so costly.” If we can address that issue, then it will come down to, “Okay, if you take that barrier away, now what's your problem?”

WTN: We have hospitals here that have put doctors and nurses right in the development process whenever an IT implementation is being designed. They are part of the process, and that helps with buy-in. Have you seen that approach work elsewhere?

Wade: That's definitely the approach at St. Luke's, where I'm still working to really make the physicians responsible for any clinical implementation. I think the success rate has been much better. You get a higher level of acceptance among the physicians, when these projects are being developed, if they feel as though they are part of the selection process. And when you engage them during the development process, you can see the results in better utilization of those functions.

On the outpatient side, it's so different because you don't employ a lot of those. In fact, you employ such a small number of the physicians that are associated with your own enterprises. This is another attempt that St. Luke's is trying to take of reaching out to the physicians, using the technology, and creating some incentives for them to embrace it.

WTN: Is there a particular model for Regional Health Information Organizations that will really catch on and accelerate their development nationwide?

Wade: I think the issue with most of the RHIOs today is the lack of a sound financial plan. I don't think the employer-sponsored model is going to be any better than some of the grant-funded models. I think what you've got up in Wisconsin [Wisconsin Health Information Exchange], where the state was a major supporter of this thing way back, had led to whatever successes you've had. On the other hand, the state can't fund this thing, so it's the coalition of the state and federal working with RHIO leaderships, which have to bring in the necessary constituents - meaning providers, both hospitals and physicians, the payers. And I think, as we go down, the employers, and I think as we go [further] down the road, financial organizations are going to take a bigger and bigger role in the RHIO operations.

This whole idea of information banks, I think beyond just the data storage, I think the issue of financial transactions, as we move into patients being more responsible for the cost of their own care and how they set up their health savings accounts, there is a natural play emerging in the financial world for that. And you see the insurance plans anticipating that, and they are becoming banks. You've got banks trying to become, in effect, insurers and insurers trying to become banks. Why? Because they want to control that dollar.

So back to the RHIO issue, how do you coalesce all of these parties that have a similar interest? Just from personal experience here in the Kansas City region, trying to get the states, in our case two of them (Missouri and Kansas), involved in this thing is problematic. One of the better ones I've seen is Utah. I also think Massachusetts, you've got strong support coming out of the legislature there that has spelled some success.

WTN: How is the Kansas City Regional Electronic Exchange (KC REE) project progressing?

Wade: Slower than cold molasses. Being candid, I think there was a sense of naivety on the founding organizations to perceive what it really takes to get these things up and running. We have it running. We do have transactions flowing through this thing, but anticipating, out of the box, what it would take to truly say, “We have a functioning RHIO organization, even at the transaction sharing level,” we grossly underestimated what that effort was.

WTN: With the two major political parties blocking each other's approach to healthcare reform, are electronic medical records the only hope of improving efficiencies and moderating the cost of healthcare delivery?

Wade: I don't think they are the only hope, but I think they are the major hope. There are other ways to have organizations become more efficient. In fact, if you were to do a case study at St. Luke's here in Kansas City, what you'd see is the process changes occurred before the automation changes. So there are still lots of opportunities in healthcare to revise processes and come up with things like best practices, by region even. Facilitating that with the exchange of information is cumbersome without any EMR.

WTN: Finally, some skeptics - including consumers and health providers with small practices and a dentist down in Texas who corresponds with me - do not believe that patient privacy is a priority in the push for healthcare IT. What would you say to reassure them?

Wade: I have a legitimate concern about the privacy issues. There, again, I think there are some legislative actions that could be taken to ensure that privacy is not abused. On the other hand, I see a move within at least the federal level to make privacy almost a barrier, and I think to the detriment of healthcare.

WNT: How so?

Wade: I think if we continue to put up barriers to the adoption of EMRs, all we're doing is delaying. It's a delaying tactic, and the more we delay, I think the greater the cost of healthcare will be in the United States. We're already at 16 percent of GDP in this country, and we're seeing a ripple effect of the current non-electronic environment in healthcare, the inefficiencies and the impact it's having on major employers.

I mean, do we really think that if we just hunker down behind this issue of privacy that the primary issue is going to get any better? It's not.

WTN: You mentioned the government putting up barriers.

Wade: There have been a number of bills introduced over the past two to four weeks in Washington around the issue of privacy. So you've got certain congressmen and certain senators proposing legislation that could make the privacy issue volatile in this country, that it will have a negative impact on the deployment of EMRs.

I think you'll see the dentist you referred to say, "See, if the legislators don't think there is enough privacy in the current environment for me to go out and invest in my electronic system, therefore I'm not." I think that's what you'll see is that the groups who aren't automated and who need to be automated - small practices especially - will use that as a crutch to say, “See, I would do it but my God, even the federal government believes that there is not enough protection there for your records. Therefore, I have to keep them on paper, the same way I always have.”

I liken it back to 1962, when President Kennedy said, "Hey, we're going to put somebody on the moon in less than 10 years," and we did. Why? Because we took, as a matter of national resolve, to get something done. At the time, we thought it was because Russia was outpacing us.

Today, in our global economy, I think if we continue to say, “Any time we can create a barrier to EMRs, community health records, and ultimately, personal health records..." Every time we let that slow us down, we're really creating a situation that harmful to our own nation.