Information Integration

Transforming healthcare with information technology

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Siemens Medical Solutions' President and CEO Erich Reinhardt (left) and Newt Gingrich discuss the impact of technology on healthcare. (Siemens Medical Solutions

Newt Gingrich
The Gingrich Group

Healthcare and Aviation: Second Cousins?

The following is an excerpt of Newt Gingrich's presentation at the healthcare though leadership seminar recently held in New York City.

I served on the aviation subcommittee, which gives me two unique viewpoints as it relates to health. One is a focus on how we think about your life when you're on an airplane. The other is what happens when markets have information.

When I was first elected, we had two DC-10 crashes on takeoff – one in Chicago and one in Mexico City. We had a national transportation board, the Federal Aviation Administration, the manufacturer of the engines, the manufacturers of the airplane, the airline pilots association and the airlines themselves. Everybody teamed together and we discovered that there was a maintenance error in how they were putting on one of the engines. Within 48 hours, every mechanic in the world who dealt with DC-10s had been retrained.

By contrast, the Institute of Medicine reports somewhere between 44,000 and 98,000 Americans die annually from medical errors in the hospital. I did have a doctor tell me once that in their judgment, that number couldn't be more than 25,000 a year. But then he stopped and stared at me and said, "I guess that's not acceptable, is it?"

You are 2,000 times more likely to die in a hospital from an error than you are to die on a civilian airline. That's a 2,000 percent difference. That's just not tolerable.

On the safety hat, I want to bring to health the same passion to you remaining alive that we brought to aviation. On the market cost hat, I represented the Atlanta airport in 1978, the first year we deregulated airlines. I then watched the rise of Travelocity and Expedia and what do you have today? – A market-oriented system with real-time information available 24/7 to every customer, with an e-ticket system to take cost out of the process.

So what's the result? The price of flying in constant dollars has gone from 23 cents a mile to 12 cents a mile since 1978. Now if you apply that to the process of health, you would first of all have agony in the system, which is what's happened to [airlines like] Delta, Eastern, Pan Am, etc.

Lots of people either didn't make it, have changed profoundly or are still in agony. But from the customer perspective you have more choices at lower cost than ever before in history. And you have it in a system that remains stunningly safe even while going through that level of change.

It's as though you took policy wants to the airport to debate whether or not the Wright brothers were going to succeed as 747s took off in the background. It's a really big gap between reality and theory, and the theory is wrong.

Expand

Technology has a tendency to transform what used to be everyday practice into an archaic absurdity. Black-and-white TVs have given way to plasma screens, rotary phones are reserved for museums as cell phones have taken hold and checkbooks have been tossed aside in favor of check cards and e-banking.

So if you can tune into hundreds of channels, call around the world from your car and pay your weekly grocery bill with the click of a mouse, why is healthcare interconnectivity still walking in the land of the lost?

The traditional film-based hand-delivered X-ray films radiologists once relied on were expected to fade away in the shadow of PACS. Industry analyst firm Frost & Sullivan estimated in 2002 that for large hospitals (500 beds or more) PACS had taken a firm hold: a 93 percent adoption rate. But as the size of the facility shrinks, so do those percentages: 67 percent adoption for those with 499 to 400 beds, 47 percent in those with 399 to 300 beds and mostly single-digit numbers in facilities with 300 or fewer beds. Those numbers relate to the facility using some sort of PACS. Completely filmless systems are far more rare.

But when the industry is ready to take the plunge, information technology (IT) will be standing in the wings, ready for action.

With the push for national healthcare information unity, it is fitting that a national leader has stepped forward to propel this important initiative. Former Speaker of the House of Representatives Newt Gingrich never had a problem commanding attention. As the architect of the Contract with America, he led the Republican Party to victory in 1994, filling the majority of seats in the House with fellow Republicans for the first time in 40 years. Now he's using his persuasive prowess to focus efforts on transforming the U.S. healthcare system.

Since retiring from Congress, Gingrich founded the Center for Health Transformation, a collaboration of public and private entities aimed at accelerating the adoption of transformational solutions, policies and technologies. "Reforming," Gingrich says, is the process of trying to make the current pattern work. "Transforming" is about developing new and very different patterns. And many believe that's the direction healthcare needs to go.

It was this transformation that was discussed at a recent thought leadership event, "Technology's Impact on the Future of Healthcare," held Oct. 13 in New York City. Gingrich joined Siemens Medical Solutions, Malvern, Pa., and leading healthcare institutions for the event.

Recently, National Cancer Institute (NCI) Director Andrew C. von Eschenbach, MD, announced the goal of eliminating suffering and death due to cancer by 2015. But the Institute of Medicine reports it takes up to 17 years for physicians to learn a new best practice. "So you can have cancer defeated by the NCI by 2015 and your doctor can learn it by 2032," says Gingrich. "In order to have the system work, you have to connect discovery in the lab, development of the capability and delivery to the patient into one seamless process. And that can only come with information technology."

At Any Cost

While the answer to the country's healthcare dilemma may lie in the abstract world of technology, past experiences have caused many to ask if advances in IT and imaging will continue to drive up the costs of healthcare. The resounding answer is no.

A survey released earlier this month from Siemens and the Center for Health Transformation reported that 60 percent of healthcare opinion leaders believe new medical technologies and equipment can actually reduce the costs of healthcare. And 63 percent believe information technologies are more important than other factors in contributing to keeping healthcare delivery costs down. The survey, conducted by PSB Corporate Research Group, polled healthcare influencers, members of healthcare professional organizations, lobby groups and hospital CEOs, CIOs and executive directors. The results were announced at the recent thought leadership event. (Click here to view the survey in PDF format.)

"The most important thing is not that health leaders now recognize IT matters," Gingrich says. "It's that 60 percent of them say it will lower cost."

"The idea that technology can drive costs down and improve care is a reality," says Erich Reinhardt, PhD, president and CEO of Siemens. "Coupled with the real-world outcomes we are seeing at healthcare facilities, these findings confirm that the return on investment for innovations in healthcare technology comes in both the bottom line and in saving lives."

Gingrich closely echoes the belief in the best of both worlds in his book Saving Lives and Saving Money: "First you save lives and then you're allowed to save money because health is essentially a moral function first. It's about people's lives and quality of life. We're looking for better outcomes at a lower cost or better outcomes at the same cost or life-saving outcomes at any cost."

One way to lower costs is to shorten patient hospital stays: a goal Reinhardt says IT has already met. "IT solutions have helped to reduce the average [hospital] stay from 4.3 days to 2.5 days," he says. "And we've been able to reduce medication turnaround time and radiology turnaround time by 64 percent and 43 percent, respectively. IT will be the backbone of serving the era of molecular medicine."

Sandra Vogeler, RN, the COO at Nebraska Heart Hospital, Lincoln, Neb., with six years' experience as a consultant implementing clinical information systems and clinical workflow design under her belt, says imaging technology will gain importance in this initiative as it hones in on better diagnosis, which will cut down invasive procedures, thereby bettering patient outcomes. "If you don't need to do an invasive procedure, a patient can recover more quickly, which also drives down costs," she says.

"A lot of healthcare entities really value today's technology, so they are willing to pay more," Vogeler continues, "and there are a lot of soft returns on today's systems. Facilities have to be willing to say that because we'll have better quality outcomes for patients, these systems will be financially worthwhile."

Out With the Old

Gingrich says his granddaughter, Maggie, may be one baby step ahead of the pros. In a toy purse, Gingrich says, Maggie found a change purse with a credit card. "In about five minutes, she said, "This white space is where my name goes.' But only last June did the state of Florida adopt a law requiring doctors to print legibly. Now the three-and-a-half-year-old is farther into the 21st century than the Florida legislature," he says. However, the silver lining is that, while Florida may be behind the times in comparative terms, Rhode Island is right on track. "The state of Rhode Island is the first state to have a statewide project on electronic prescribing. And that is an enormous step. You show me paper prescriptions, I'll show you medication errors. You show me a hospital that does not have bar coding and I'll show you a hospital that is making mistakes and killing people," he continues. But luckily, some trailblazers are setting an example worthy of imitation.

Lifespan, Rhode Island's first health system, was founded in 1994 by Rhode Island Hospital and the Miriam Hospital in Providence. The health system coordinated efforts with Siemens to implement a wide-scale deployment of Invision™, a computerized physician order entry (CPOE) system. To facilitate the CPOE system, Reid Coleman, MD, Lifespan's chief medical informatics officer, developed an e-mail feedback system to help IT staff work more closely with clinicians to design order sets that match physician ordering patterns and report back on system satisfaction. Clinicians also utilize personal digital assistants and a wireless network to review and capture pertinent patient data at the point of care. Coleman also launched a unique IT department rotation for residents. To date, 10 residents have completed one-month tours of service within the system's IT department.

CPOE systems help create an interactive care model that supports decision-making, reduces variance in care and enables providers to work together as an efficient team. But less than 5 percent of the nation's hospitals utilize CPOE.

Danville Regional Health System in Danville, Va., the most comprehensive provider of healthcare in the Dan River Region of Virginia and North Carolina, also seems to have the right idea.

The facility's clinical staff began implementing Siemens' bar code medication administration product, Med Administration Check™, in 2000 to support the entire workflow of medication delivery. The application helps nurses verify and document medication administration at the point of care. Using wireless computers containing electronic medical records and wireless bar code scanners, nurses scan the bar code on a patient's ID badge, which displays an online medication administration work list on the computer. The bar code on the medication is then scanned and the system automatically checks the scanned medication against the medication ordered.

The computer then verifies that the five "rights" of administration are accurate – right medication, right dose, right time, right route and right patient. If there is a discrepancy, an alert appears on the computer screen, warning the nurse that one of the five rights is being breached, preventing a potentially fatal error.

Danville has documented an average of 118 potential medication errors avoided each month and an average annual savings of $943,805 due to increased efficiency.

Although these facilities seem to be plugging forward, Gingrich says, "If you look at the level of connectivity outside of health, you know there is a huge gap between what's possible and what's currently happening."

A Nation Divided

To bring healthcare up to par, David Brailer, MD, PhD, national health information technology coordinator for the U.S. Department of Health and Human Services, and the Bush administration have challenged the healthcare community to achieve a national electronic medical record (EMR) in the next 10 years. Those polled in the Siemens survey confirm the need for industry-wide adoption of a national healthcare IT infrastructure. Nearly two-thirds say healthcare IT will have a very significant role in sharing best practices across the industry for better outcomes.

It's no secret that sophisticated technology comes with a pretty price tag, which is in large part why 300-bed facilities have been slow to make the change. Even larger facilities are sometimes reluctant to sign by the "X." It's obvious that many facilities need a helping hand, but who should answer that call?

One solution, say Siemens study participants, is the government, with 51 percent of respondents agreeing that Uncle Sam should be responsible for paying the bill for IT improvements in healthcare, second place to 57 percent who say the healthcare industry, including payers, should take responsibility. Other answers include patients, doctors, manufacturers, healthcare facilities/organizations and other groups.

"There are two essential elements for the successful development of interoperable nationwide health IT infrastructure," says Gingrich. "The government must play a leadership role and must also provide an initial investment in the nation's electronic infrastructure. As an initial goal, 1 percent of federal healthcare spending should be invested in health IT. If the government is serious about creating this national health IT infrastructure, it needs to get serious about funding it."

"I agree with Newt Gingrich that the government should be willing to help," Vogeler says. "IT systems are very expensive. The government and some of the IT providers should help out with low-interest loans. It doesn't need to be free money, just less expensive money."

While he says Brailer's biggest assignment is to "establish general patterns of connectivity that create a single, seamless system," Gingrich has some recommendations for the system of the future. He says it should be open-ended so it can keep evolving. It should be able to "talk" with any other system. And he says the federal government should establish a complete, national biological defense system and accept that that goal is "comparable to [President Dwight] Eisenhower announcing the Interstate Highway System, which was originally a national defense highway."

Gingrich says in addition to collaborating with the Bush administration, his group has worked with Rep. Patrick Kennedy, D-R.I. – which he jokes is something "that got some brows raised" – as well as Sen. Hillary Clinton, D-N.Y., and Sen. Charles Schumer, D-N.Y. "I sense a bipartisan commitment toward finding out how to move toward a genuinely seamless integrated information technology health world over the next six to 10 years," reasons Gingrich. "My hope is that the new Congress coming in [will focus] on IT and modernizing the health system."

Not only will interconnectivity play a key role in the future of the U.S. health system, so will consumerism, which has long been a stranger to healthcare. Gingrich says the industry should surround individuals with information so they can manage their own care. "If you look at studies in cost and quality outcomes, the best hospitals are often less expensive because they have fewer medication errors, fewer mistakes, earlier detection and a faster migration to best outcomes," he says, "but we haven't established the right to know."

Healthcare consumers are generally left in the dark, says Vogeler. "A lot of consumers are not educated about what they're getting for the cost. They don't go shopping for healthcare like they do a new car or a new computer and look at the quality compared to the cost. The system isn't really set up to allow consumers to be smart consumers."

"Only when citizens are involved will we get the breakthroughs we need," Gingrich says. "Only when citizens are involved will we save lives and save money. Transforming health and healthcare is a big canoe. We need all the paddlers we can get."

"But it's not really enough to say we need IT in order to improve workflow," says Reinhardt. "All the other components – all the diagnostic modalities – need to be designed such that they support the clinical application. Innovation and technology make a contribution to improve the efficiency of the clinical application."

"I think [IT] will have an enormous impact on the system. We have to establish as an unequivocal premise that absence of information technology kills," Gingrich states. "By the end of the decade, I think we will be saving an amazing amount of lives and we'll be pleasantly surprised to discover we're also saving an amazing amount of money."

— Deven Kichline is the associate editor at RT Image. Questions and comments can be directed to dkichline@rt-image.com.