Reaping the Benefits of Health IT: Q&A With ONC's Dr. David Blumenthal

David Blumenthal, MD, director of HHS' Office of the National Coordinator for Health Information Technology, discusses how providers can increase the positive impact of health IT, recoup the expense of implementation and assuage patient fears about privacy issues.

Q: A study you co-authored for Health Affairs indicates an overall positive impact of information technology on healthcare facilities. In your experience, what mistakes do providers and facilities make that decrease the positive impact of health IT?

Dr. David Blumenthal: It's a great question. I think in hospitals and in ambulatory settings, one of the mistakes people sometimes make is failure to train and failure to plan. The idea that you can get the machine and turn it on and be ready to start on day one is not correct. In hospitals especially, you need to train not just doctors and nurses, but pharmacists and anyone who's using the technology. Make sure that the training is job-appropriate and pitched at the level that people can accept, to prevent the chaos that occurs when people come in to take care of patients and everything is different.

Q: Can you estimate a length of time that facilities should plan to dedicate to training?

DB: All I can say in general is more than they think. It does require that they get help. If they're small practices, they can use regional extension centers, or if they're larger institutions, vendors sometimes offer training programs. They need to find them and use them. Pilot it and test it and do it methodically, whether you go unit-by-unit in the hospital or start with the ER. Each hospital is going to be a little different. … There's a growing community of information about how to implement effectively, and I know the American Hospital Association has put out an implementation guide. I would imagine that some of the other physician organizations have done or will do the same. It's not mysterious anymore, but it is a big change.

Q: Smaller facilities may struggle to find the capital to implement sophisticated IT systems. How do you recommend these facilities best use their new IT to increase cost-savings and recoup that money?

DB: It's pretty well-documented in small practice and outpatient settings that charge capture is much more effective with electronic health records than without, and I think that's one lesson that seems to stand up to the test of experience. It's usually offset to some degree early on by reduced productivity, and I do think physicians have to plan for reduced productivity. They may want to lighten their patient load. In a big institution, it seems to me that giving physicians and nurses extra time to see patients makes a lot of sense, not docking their incomes. I think the big source of additional revenue is in charge capture. I also imagine that reminders that physicians and nurses and others receive to do [preventive] tests could also increase the volume of services. Preventive tests such as colonoscopies, mammograms, pap smears, hemoglobin A1cs, vaccinations — I could imagine the volume of those services, all of which would be revenue-generating, would go up, and that would be a win-win. Providers are generating revenue and patients are healthier.

Q: Patient involvement is important to maximize the reach of EHR, but a recent survey indicated a certain level of patient discomfort with the new technology. What can providers and facilities do to increase patient involvement with health IT?

DB: My view is that most patients will accept whatever their main caretakers think is important for their care. Probably the most important advocate for EHR in the life of the patient is the doctor or nurse or physical therapist, someone they interact with and trust every day. I doubt many patients will walk away from a practice because they've adopted EHR; most patients already believe that their physicians and nurses have them, but what they really have is billing assistance. So I don't think patients are really a big obstacle, but I do think one way to get patients to bond with change is by giving them remote access to their records through a portal. Enabling them to email the physicians, enabling them to refill prescriptions, make appointments online … God knows we all have experience with being put on hold by doctors' offices, and all you want them to do is refill your blood pressure medicine.

Q: The survey specifically suggested that patients fear electronic medical records could jeopardize the privacy of their health information. What can be done to reduce that fear?

DB: Well, we have to make them more secure. One thing we're doing is trying to figure out how to make EHR automatically encrypt patient records, both at rest and in transit. The leading cause of lost patient information is not the Russian Mafia hacking into someone's system, but a doctor who takes home his laptop and leaves it on the subway or in the car and someone breaks in and steals it. Or they lose their flash drive and the patient information is not encrypted. Or it gets sent by mistake through an email attachment to someone who shouldn't get it. Those are the biggest sources of lost health information, and they are all preventable through good information hygiene — through encryption and management of how information is stored, so that it's not stored on laptops or USB drives and, if it is, that it's never taken out of the facility. You see the same problems with security in the national security area. People take home something they shouldn't take home and it gets lost and becomes a big security problem.

Learn more about the ONC.

Read more about Dr. David Blumenthal:

-Dr. David Blumenthal: Imaging Could Be Part of Meaningful Use

-National Health IT Coordinator Wants to Pick Up Pace on Information Exchanges, Interoperability

-National Coordinator David Blumenthal Assures Specialists Can Meet Meaningful Use Requirements

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