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2014年の世界の医療の大変革は、ICTの急激な普及

 

This year's Most Wired hospitals are moving deeper into data analytics and population health management. It's a steep climb.

 

To understand what it means to be a Most Wired hospital, head about 40 miles east of Indianapolis to Rushville, Ind., and pop into Rush Memorial Hospital.

 

While there, it is likely you'll find clinical and administrative leaders leveraging information technology systems to improve operational performance.

 

"Our hospital administrative team reviews data weekly and monthly with the aim of reducing errors or increasing percentages," explains Jim Boyer, chief information officer of the critical access hospital. "Most of the data are delivered in the form of reports, clinical decision support or scorecards across the organization, thus impacting patient care."

 

A prime example of that impact: zero patient harms between September 2012 and September 2013, an achievement the hospital hit as part of the Health Research & Educational Trust's Hospital Engagement Network. Structured data from the health IT system created an environment in which clinical teams could target specific areas to reduce readmissions and improve quality across the board, Boyer says. Leadership also relies heavily on IT systems to position the organization for the next generation of care delivery.

 

"To get to the future state, our strategy reflects around second-curve metrics, thus aligning our health care system, physicians, clinical and nonclinical people across the continuum of care," Boyer says.

 

It's a strategy mirrored by many of the hospitals appearing on the 16th annual Hospitals & Health Networks' Most Wired list. These hospitals have effectively deployed such foundational technologies as computerized provider order entry, alerts and medication matching at the bedside, and now are eyeing data analytics and population health management. These are steep hills to climb.

 

Among Most Wired hospitals, 36 percent conduct controlled experiments or scenario planning to make better management decisions and to do forecasting, according to the 2014 Most Wired Survey. The percentage drops to 27 percent for all respondents. Additionally, 61 percent of Most Wired hospitals, compared with 49 percent of all respondents, use predictive modeling and data to improve decision-making across multiple departments. From a glass-is-half-full perspective, these characteristics are on the rise from previous years.

 

"We see leaders thinking about business intelligence tools. We also see consistency among hospitals' delivering quality metrics to clinicians," says Chantal Worzala, director of policy at the American Hospital Association. "The question is, 'Can we give them time to build out better analytical tools?' "

 

Breathing room

 

Worzala echoes a near-universal concern that federal mandates for hospitals and physicians to adopt health IT systems were too much, too fast. To be sure, hospitals have been putting electronic health records in place at a staggering rate. Nine in 10 hospitals possessed a certified EHR in 2013, up from 29 percent in 2011, according to a May report from the Office of the National Coordinator for Health Information Technology. Yet, the ONC data, based on an AHA survey, show that the vast majority of hospitals — 60 percent — had a basic EHR, meaning it lacked such advanced tools as clinical decision support.

 

Additionally, in the rush to meet Stage 1 meaningful use requirements, some hospitals implemented systems without fully assessing the impact on clinical processes, says Russell Branzell, president and chief executive of the College of Healthcare Information Management Executives, a partner on the Most Wired Survey.

 

"In many cases, the systems were not built for maximized workflow," he says. "We are seeing hospitals now having to reinvent processes or retool their systems. That's disappointing because it is like putting in a whole new EHR."

 

Acknowledging provider concerns, federal regulators in May proposed extending the compliance time lines for meaningful use Stages 2 and 3. ONC and Centers for Medicare & Medicaid Services officials also noted that vendors have not been able to keep pace with the demand to get certified products to the market. At press time, a final rule was not anticipated until at least September, which means that hospitals still could face compliance deadlines this summer.

 

The march to value

 

Regardless of CMS' overture of increased flexibility, CIOs completing the Most Wired Survey say the next hurdles to jump revolve around analytics, population health and the overall push to a value-based environment.

 

"We are using real-time algorithms within and outside of the EHR to look at risk, and predict and inform clinical and operational pathways," says Steve Hess, CIO, University of Colorado Health. "While still early, we are starting to see patterns related to how our patients are interacting with our system and the reimbursement impact of those changes. It is important that our systems are set up to provide the complete patient picture and to ensure that the patient is getting the appropriate care in the appropriate setting at the right time."

 

Creating a more complete view of patient patterns is critical to population health management. Just as important is creating scenarios in which clinical and claims data are viewed together, says Rose Higgins, senior vice president and general manager, population and risk management at McKesson Health IT, a survey sponsor.

 

"You need both to be successful," she says. "Seeing them together will provide a better picture of what's happening at the population health level and will be important as hospitals take on more risk."

 

Hospitals are just beginning to scratch the surface of what's possible. Roughly one-third of all respondents and 43 percent of Most Wired hospitals integrate clinical and claims data that are accessible, searchable and reportable across the continuum of care. Also on the population health front, 69 percent of Most Wired hospitals and 55 percent of all respondents conduct a retrospective analysis of clinical and administrative data to identify areas for improving quality of care and reducing costs.

 

As hospitals move toward accountable care and other value-based models, CIOs need to be front and center in the strategic and tactical discussions, says Branzell, a former health system CIO.

 

"We should be facilitators for those discussions," he says. "A big part of this is figuring out what data clinicians need to do their jobs well. What data support the workflow and improved efficiencies? It's got to be a collaborative effort. It is not something that IT does on its own."

 

Making the right decisions

 

Most Wired hospitals also are ramping up activities around patient engagement, which will prove vital in a value-driven health care economy. The focus isn't just on kiosks and electronic bill pay, although those aren't insignificant. Rather, there's considerable activity around all aspects of patient engagement, including chronic disease monitoring and mobile health applications. For instance:

 

82% of Most Wired hospitals allow patients to check test results via a portal.
53% of Most Wired hospitals offer patients with chronic conditions self-management tools via a portal.
58% of Most Wired hospitals offer an mHealth app that provides access to the patient portal.
40% of Most Wired hospitals offer secure messaging.

 

Although some of these percentages may seem low, given the pace of IT adoption in other parts of the economy, they are indications that health care is catching up. Having learned their lesson from Stage 1 meaningful use, though, some CIOs recognize that they need to be deliberate in how they move forward.

 

"The proliferation of devices that capture electronic information, the integration with health information exchanges, and the automation of many of the clinical and operational systems have led to many advances that we have never had previously," Hess says. "But it also leads to a lot of data that may not be clinically relevant or relevant for the specific episode of care. We need to find ways to collect all of that data, but eliminate the 'noise' to enable our clinicians and staff to efficiently and effectively make the right decisions."

 

 

 

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