By Brandon Savage Chief Medical Officer for GE Healthcare IT

Over the next two years, electronic health record (EHR) adoption in the U.S. is expected to reach very high levels as healthcare organizations continue to progress in the vast arena of delivery system reform by reducing costs and improving quality of care. The federal government will invest $30 billion in healthcare IT in the next decade, primarily through financial incentives for healthcare providers who demonstrate Meaningful Use of their EHR.

This past year has brought continued maturation of the industry, with an associated shift in the way healthcare organizations compete. As providers and payers move toward new models of payment, organizations will need to transform all aspects of care delivery – optimizing processes, reducing waste, and improving quality and performance. Healthcare IT will form the backbone of systems that pay for the value of, rather than on the quantity of, services delivered.

With this large scale transformation of healthcare, empowering patients to become more informed and engaged is a must. For far too long, the patient voice has been missing from the healthcare dialogue. Without question, informed and engaged patients demand value and performance from their healthcare system, which creates healthy and positive market pressure. More importantly, however, informed and engaged patients better manage their own health – with a particular focus on overall wellness, prevention, and care management. These engaged patients will become active members of their own care teams and will be looking for more ways to collaborate with their healthcare providers.

Meaningful Use – and its attendant stages of maturity – requires the use of technology to enhance information transparency, improve quality and outcomes, deepen care coordination and increase patient engagement. In fact, a growing number of CIOs are realizing the need to generate long-term value from meeting initial and subsequent Meaningful Use measures. For example, the proposed and expected requirements for Stages 2 and 3 of Meaningful Use would require greater use of patient engagement and communication tools—including electronic self-management via patient portals, EHR interfaces to patient health records and patient reporting of care experiences online. Physician practices such as Heart & Vascular Center of Arizona are already expanding the use of patient portals to communicate test results and follow-up care instructions for home monitoring of chronic conditions such as congestive heart failure and diabetes.

Participation in emerging models such as value-based payment, patient centered medical homes, and Accountable Care Organizations (ACOs) is also gaining traction. Today, there are several pilot programs—Geisinger Health System, Piedmont Physicians (Ga.), with a group selected by Dartmouth-Brookings, and others–that have embraced these models and are actively working to improve healthcare. These initial pilots and others will help bring needed clarity to this important initiative as CMS prepares to finalize ACO regulations and roll s out payment reform and accountable care pilots.

The CMS ACO approach has three goals: better care for individuals, better health for populations, and slowed growth of system expenditures. The ACO proposed rule, like many proposed rules, generated many criticisms and will likely undergo substantial revision before it is finalized. In addition, there will be many flavors of accountable care—many of which may emerge from existing examples of high performance care.

Regardless of the fate of this proposed regulation, the building blocks of accountable care will be increasingly important for providers. These include population accountability, payment reforms, care coordination, patient engagement, and quality measurement. These approaches all share the need for robust healthcare IT – including clinical, administrative, financial, and health information exchange (HIE) solutions.

While the proposed regulation for ACOs are debated vigorously, community-wide and IDN-based HIEs have existed for a few years and can facilitate a high level of care coordination that runs as part of – or in parallel to – an ACO. Expansive health networks that connect several major hospitals in a region would be well positioned for an ACO approach since information is already consolidated and coordinated at the patient level. Moreover, interoperability, clinical integration, and analytics will begin providing the baselines and evidence upon which incentive payments will be based.

Due in large part to federal initiatives and funding prior to and under ARRA’s HITECH Act, the community model for HIE has emerged as an increasingly effective approach for providers and health systems to achieve interoperability across communities. The ONC Beacon Community Program has been a key driver in these efforts. In Northeast Pennsylvania, a $16 million Beacon grant will enable Geisinger Health System and the Keystone Health Information Exchange (KeyHIE) to make healthcare IT-supported care coordination available to a community of more than 250,000 residents, particularly in rural or medically underserved areas. Caregivers and case managers connected to the network will have access to patient information that allows them to improve follow-up with patients after discharge and reduce the rate of hospital readmissions.

Against the backdrop of the national dialogue on healthcare reform, a confluence of key factors, including the definition of Meaningful Use Stages 2 and 3, as well as the maturation of digital patient engagement tools, will undoubtedly characterize 2011 as a tipping point for strategic implementation of healthcare IT. Most healthcare professionals agree that ACOs and similar payment and delivery system innovations should enable care teams to improve quality and reduce costs by better aligning incentives with clinical outcomes but, beyond this broad intent, how ACOs will be defined and managed remains to be seen. As we move forward, organizations that can continue to optimize cost, quality, and access will emerge stronger than ever on top of the competition.

About the Author:

Brandon Savage, MD, is the Chief Medical Officer for GE Healthcare IT. As CMO, Dr. Savage is responsible for building GE’s clinical IT vision, driving this vision into current and future IT products, and facilitating integrated product solutions that enable digital communities and early health.

Previous to his CMO role, Dr. Savage served as the General Manager of Global Marketing for GE Healthcare IITS. During his tenure, Dr. Savage also led the development of products, such as computerized provider order entry (CPOE), and worked with customers to select and
implement software solutions.

Prior to GE, Dr. Savage practiced internal medicine and served as an assistant professor of medicine at the University of California, San Diego, with a focus on clinical trials, patient safety, and residency training. During this time, he also co‐founded Intensive Solutions International, which developed software for managing patients in intensive care units.

Dr. Savage has a Bachelor of Arts from the University of California, Berkeley, in molecular cellular biology and a Medical Doctor degree from the University of California, San Diego.