To encourage development, diffusion, and adoption of innovations in healthcare, the Agency for Healthcare Research and Quality (AHRQ) recently launched a new online “best medical practices” information exchange. The Healthcare Innovations Exchange is a searchable database of treatment innovations that improve patient outcomes.
AHRQ is an agency of the Department of Health and Human Services. It is charged with research and development of best medical practices. The goal of this free service, which currently contains more than 200 innovations, is dissemination of information about best practices among healthcare facilities.
Users can search the database for innovative practices by one or more subject fields. These fields include disease or clinical area, patient population, stage of care, patient care process, care setting, and domain of quality. Each “best practices” case study often represents a remarkable innovation. One example is an infection surveillance system that completely eliminates vancomycin-resistant enterococcus infection in an ICU for transplant patients. Another is a system that reduces the incidence of bed sores by 5% in high-risk nursing home patients.
Too often, innovations within one healthcare facility remain unknown to the wider healthcare community. A primary goal of this AHRQ Website is to overcome that “silo” effect and make the knowledge available to a wider community. To accomplish this objective, the Innovations Exchange program provides practitioners a standardized format for submitting ideas. The format includes an outline of the medical issue addressed, a description of the innovation, journal references that support the concept, and results attained when the practice was tested. The listing also provides information on how the innovation was implemented, resources required to adopt it, and contact information for innovators and other adopters.
The Web site links to other online tools for quality improvement, such as Joint Commissions’ Laboratory Services National Patient Safety Goals and American Association for Clinical Chemistry’s Lab Tests Online.
Not surprisingly, the Innovations Exchange Web site has not been flooded by visitors, since many healthcare providers are reluctant to change, let alone be innovative. One year into this service, few innovations listed have generated similar projects. For example, a system for reducing “door-to-balloon time” for heart attack to as little as 82 minutes-well below the national 90-minute average-was posted in May, but its creators have not received a single call.
AHRQ’s Innovations Exchange Web site is one more small step in nudging healthcare providers toward a mindset of continuous improvement. As policymakers and payers turn up the heat on hospitals and physicians to deliver improved outcomes in return for pay-for-performance incentives, providers can be expected to pay more attention to fostering innovation within their organization.-P. Kirk
As the nation’s healthcare system pursues the goal of a universal electronic medical record (EMR) and a paperless, all-electronic environment, one barrier to adoption may be the large number of physicians nearing retirement. That’s the opinion of a neurosurgeon in his recent testimony before a congressional committee.
Physicians within five years of retirement may not get a return on their investment, Philip Tally, M.D., a neurosurgeon in Bradenton, Florida, told a hearing on “Cost and Confidentiality: The Unforeseen Challenges of Electronic Health Records in Small Specialty Practices,” on July 31 before the House Committee on Small Business.
Just 4% of physicians have an extensive, fully functional EMR and only 13% have a basic system, Tally told the committee, citing an article, “Electronic Health Records in Ambulatory Care-A National Survey of Physicians,” in the July 3, 2008, issue of the New England Journal of Medicine. The committee hearing was on the unforeseen challenges faced by small specialty medical practices when installing an EMR system.
“If you’re not thinking about practicing more than five years, don’t bother because the transition and the cost and the time to make it proficient for you in a small practice is probably not worth it-with one exception and that would only be if you intend to sell your practice someday,” Tally told Modern Healthcare magazine. When selling a practice, the physician who buys the practice is likely to want the EMR, he added.
The American Medical Association’s Physician Characteristics and Distribution in the U.S., 2008 edition, shows how physician demographics are weighted toward approaching retirement. There are 921,900 physicians in this country, of which 343,200 (37.2%) are over age 54. Approximately 166,000 physicians are aged 55 to 64 and 177,200 are aged 65 and older.
Interestingly, Tally was speaking from experience. His three-physician practice of neurosurgeons installed an EMR in 1992, making the group just the fifth in the nation and the first neurosurgery group to do so. At the time, the practice spent $50,000 for the EMR and about $5,000 annually to maintain the system. Tally, who chairs the Florida Medical Association’s IT committee, the congressional hearing that his group spent about 1,000 hours to configure the system after it was installed. His medical office staff found the process challenging, as the staff turnover rate climbed to 30%. Tally did observe that the EMR system, once implemented, significantly increased productivity.
Accurately measuring the return on investment (ROI) that accrues to a physician group from implementing an EMR is complicated by many factors. These include: 1) savings from eliminating the need to maintain and store paper charts; 2) savings in time for physicians to see patients under the new EMR system versus the time it took under the old system; and, 3) savings from electronic data entry of laboratory tests results in the EMR. Perhaps most difficult to measure is physician and patient satisfaction with the new EMR system versus the old.
Tally has an overlooked perspective on why physician age is likely to be an impediment to EMR adoption. He points out that more than one in three physicians in this country are within a decade or less from retirement-and are thus likely to find the transition to an electronic medical records system to be both uneconomical and unwelcome. It may turn out that more financial incentives from federal and state government sources, along with private payer incentives, will be required to encourage smaller physician groups to implement an EMR system. Clinical laboratories will need to take these factors into consideration as they develop effective strategies for supporting to move to a fully-digital patient health record by their office-based physician clients.
Physicians in America (In round numbers)
Younger than age 35 141,500
35 to 44 213,300
45 to 54 223,900
55 to 64 166,000
65 and older 177,200
Source: American Medical Association’s Physician Characteristics and Distribution in the U.S., 2008 edition
Dr. Tally’s prepared remarks for the House Small Business Committee:
Committee Examines Costs and Challenges of Electronic Health Records to Small Medical Practices