Study: HIT infrastructure an afterthought in rush to deploy new systems

Simultaneously changing both the infrastructure of a health system to support expansive health IT efforts and the methods by which IT tools are deployed is a process that will take time and mature unevenly in different settings, according to new research published online this week in the American Journal of Managed Care.  

For the study, Marsha Gold, a senior fellow at Mathematica Policy Research in Washington, D.C., interviewed several federal and health system leaders on behalf of the Office of the National Coordinator for Health IT; the work, as stated, is part of a larger assessment of the HITECH Act.

In particular, Gold says, health IT needs to be considered more than just electronic health records to be useful. To that end, she says, practices need to build up infrastructures that are "sufficiently robust."

"More broad-based reform of delivery that builds on medical homes and neighborhoods to support accountable care organizations, and bundled care models create financial incentives to encourage providers to take responsibility for the care of patients, regardless of where the patients seek are," Gold says. "Providers in ACOs have to be able to track patients wherever they obtain care. Tracking patients may necessitate capabilities such as cross-continuum medical management, medical engagement, clinical information exchange, quality and performance reporting, predictive modeling and analytics, and administrative and financial management systems.

Adds Gold: "These capabilities require an infrastructure that moves beyond 'point of care' and 'encounter-based' functionalities and supports more robust information exchanges across settings, as well as more rigorous population-based analytics."

Support for properly building such an infrastructure, however, may be lacking, Gold says. Instead, she says, policy makers are looking for instant gratification, i.e., delivery models being rolled out as infrastructure is being built, which in turn results in heavy tension.

"Although rapid change may be appealing, the reality is that the transformation of delivery systems--and the development of infrastructure to support them--will take substantial time and will progress unevenly across the nation," Gold says. "If policy makers are serious about transforming the delivery of healthcare ... they need to recognize these realities and develop practical strategies to deal with them over a relatively long time horizon."

According to a recent survey of hospital CIOs, most respondents said they have felt pressure at one time or another to continue launching a project that was not ready for go live.

John Halamka, CIO at Boston-based Beth Israel Deaconess Medical Center, says in a recent blog post that he sees signs that the various federal health IT mandates on the horizon will cause problems for even "well resourced" health institutions.

To learn more:
- read the AJMC study

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