Health information technology (IT) will take center stage early and often at this year’s annual meeting of the Society of Hospital Medicine.
Karen DeSalvo, MD, MPH, MSc, acting assistant secretary for health in the U.S. Department of Health & Human Services (HHS) and the national coordinator for health information technology, will deliver the keynote address. She is scheduled to give her talk an hour into the first day of programming.
Another highly anticipated talk will be delivered by Robert Wachter, MD, MHM, chief of the division of hospital medicine at the University of California at San Francisco, the “godfather” of hospital medicine, and the field’s most well-known practitioner. Dr. Wachter will give his 12th straight meeting-closing talk at noon Wednesday.
Dr. DeSalvo, an internist by training, was the chief of general internal medicine at Tulane University for about 10 years. She also started at Charity Hospital in New Orleans, site of one of the earliest hospital medicine programs.
She says her speech will take a broad look at information technology as a tool for advancing good health, with attention to the role that hospitals and hospitalists play. She also plans to touch on the successes in U.S. healthcare in recent years, including expanded coverage, quality and safety improvements, and the rapid rate of adoption of electronic health records (EHRs), especially in the hospital. She says the hospital setting is “most ripe” for health IT advancement because it is the site of “the most rich data about the patient’s care and care experience and health … and there is the best interoperability right now between hospital systems and the best opportunity to make that more seamless.”
The future, she says, will be about “much more than the electronic health record.”
“I want to talk a bit about what’s happening on the pioneering edge in health IT, ranging anywhere from apps to consumer interface with digital health records to some really on-the-edge things like using telehealth and hologram technology for remote patient care,” she explains.
Dr. DeSalvo also plans to underscore health IT’s key role in HHS’s push for delivery system reform: changing the way care is paid for and delivered and the way information is delivered. HHS’s goal is for 50% of payments to be in the form of alternative or value-based payment models by 2018. Without health IT advancements, that won’t be possible, she says.
Health IT policy at HHS, she notes, has centered largely on “freeing the data” so that information is no longer trapped within a particular EHR system. A rule taking effect in 2018 will require that EHRs be built so that apps can be overlaid onto the data, allowing easier access and the ability to tailor data to an individual’s needs.
“It’s going to get to be more like the way we do our banking or call for transportation with a smartphone or have an interface for our travel arrangements,” she says. “That’s the way that the health IT world is evolving.”
She says hospitalists are “pioneering, early adopters who are by nature very innovative” and are ideal for helping refine health IT. But she also recognizes that the bumps along the way can cause technology to be seen as a hurdle. That’s why HHS policy has focused on making data more readily available, smoothing out clunkiness, making EHR vendors become more transparent about their products, and aligning documentation requirements with real patient outcomes so that unnecessary requirements can be eliminated.
Good systems have been developed, but improvements are needed, she acknowledges.
“We’re working with an intense sense of urgency at HHS because we know that is a source of frustration to doctors on the frontlines,” Dr. DeSalvo says. “We not only hear it all the time when we’re out speaking with folks, but some of us still practice and will shortly be practicing again, so it’s very real to us to know that this has to get better. What we don’t want is for people to be frustrated with the technology. We want it to lift them up and help make their practice better. We also want it to be an enabler for consumers.”
Dr. Wachter has an easy way to remember how many annual meeting lectures he’s given: The 10th was the one where he dressed up as Elton John, sang, and played the piano on stage. That was in Las Vegas, of course.
This year? Don’t expect the piano, or singing for that matter. His HM16 theme will be more sober, one of caution and the importance of perspective.
The early title, he tells The Hospitalist, is “Why Culture Is Key to Improvement … And Why Hospitalists Are the Key to Hospital Culture.” The title might change, and the precise direction and details of his talk are still in flux, he says.
But the thrust will be a concern that, with a blizzard of quality improvement (QI) projects and process analyses being taken on by hospitalists, hospitalists are not immune to the burnout we’re seeing throughout medicine. A bad vibe is creeping in, he fears, and unless there’s more awareness of, and attention to, the culture itself—and not just a grim soldiering on from one initiative to another—the field will suffer.
“There’s a risk that we’ll lose sight of the people and culture within the organization,” Dr. Wachter says. “Even good people are beginning to say, ‘I just can’t do another QI project; I just can’t do another thing.’”
He wants hospitalists to think “more deeply” about the issues of culture, how the workforce is being managed, and “that we’re focusing on the right things in the right way.”
He hopes to call on hospitalists and hospitalist leaders to continue to recognize “the importance of the human spirit in all of this.”
So how worried is he?
“It won’t be a downer,” he says. “I still think we’re in great shape, but I am a bit worried, in part, because of our successes. We grew so fast, and we became so important to our organizations. We have to be sure we’re taking care of ourselves.”
So many hospitalists now have leadership roles. That’s a good thing, he adds, “but it does mean that as people are beginning to be burned out or organizations are struggling with dealing with initiative fatigue, we’re the first ones that are going to feel that because we are disproportionately involved.” TH
Thomas R. Collins is a freelance writer in South Florida.