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Pictured left to right, first row: Meredith Taylor, director, congressional affairs, HIMSS; Dr. Juan Reyes, chief medical resident; Gretchen Tegethoff, MSIST, CPHIMS, CIO/director, IT, George Washington University Hospital; Sharon F. Canner, director of advocacy programs CHIME; Carolyn Wise, Congressman Randy Forbes (Armed Services Committee); Camille Sealy, Rep Towns (D-NY), Energy and Commerce Committee; Blair Hedgepeth, senior manager, congressional affairs, HIMSS.
Second row: Travis Robey, Congressman Thompson, (Ways and Means Health Subcommittee); Geoff Gerhardt (Ways and Means Health Subcommittee Chair); and Dennis Worden, Rep. Wu (D-WA), Committee on Science and Technology. |
Academic medical centers have specialized needs in using electronic systems to document patient observations and care, facilitating handoffs in care between clinicians, and achieving accurate billing. Those needs require extra customization of IT systems and additional expense.
Staff members supporting key congressional committees got a first-hand look at those and other concerns last month as they caught a glimpse of the complexity of HIT during a site visit to The George Washington University Hospital, Washington, DC.
The event was jointly organized by The College of Healthcare Information Management Executives (CHIME) and the Healthcare Information and Management Systems Society.
On Nov. 17, five staff members were on-site for nearly two hours at the facility, which is the closest hospital to the White House. The staff came from the House Energy and Commerce Health Subcommittee, the Senate Budget Committee, the Senate Aging Committee, the House Small Business Committee, and the House Ways and Means Committee.
Staff were briefed in an orientation meeting and then met with physicians and nurses before seeing how IT aided the care delivery process, including observing the facility's emergency department (ED) in action.
"From the tour, I think they appreciated seeing the ED in full motion and with a pretty full patient load," said Gretchen Tegethoff, CIO and director of IT for The George Washington University Hospital.
"The purpose of the visit was really to show how IT is used and how it can improve patient care," said Sharon Canner, CHIME's director of advocacy. "It is important for representatives in Congress to understand that HIT is a complex process that affects not just computer systems and staff, but also patients."
Congressional staff found the trip valuable and appeared to be learning insights that will help them in considering HIT policy for the country, said Tegethoff, who also is vice chair of CHIME's Advocacy Leadership Team.
"They seemed to be fully engaged and asked very good questions. They focused on how the systems were integrated, the auditing functions that we perform to determine who has accessed and updated the records, and the decision support functions," she said. "I believe it was successful in that we touched on some areas that may have been eye-openers for several in the audience."
The hospital, an academic medical center, has had an electronic health record (EHR) in place since 2006, but the application is not a total solution for the facility, which must manage patient observations and notes from medical students and residents, and requires that supervising physicians oversee their work and sign off on their clinical decisions.
Using better and clearer electronic documentation -- instead of relying on handwritten notes -- has provided enhanced patient safety, because there's no problem with legibility.
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| Camille Sealy, Rep Towns (D-NY), Energy and Commerce Committee; Carolyn Wise, Congressman Randy Forbes (Armed Services Committee); and Dr. Robert Shesser, professor and chair, department of emergency medicine. |
During the tour at The George Washington University Hospital, congressional staff members "learned that even though an EHR may be implemented, it may not satisfy all needs, especially for specialized areas," Tegethoff said. "Sometimes niche systems are necessary, and we have several in our environment. We showed them our physician documentation and communication system, which overlays our existing EHR."
The facility has implemented TeamNotes from Salar Inc. to handle the complex documentation issues inherent in teaching facilities. These include requiring signoffs on medical student observations by supervising physicians. Because the system helps improve documentation, it provides vital assistance in coding and billing.
Integration issues are complex and costly problems for academic medical centers, and congressional staff members learned how funding affects hospitals' capabilities to both support and customize information systems after they're installed.
"We discussed how both human and budgetary resources are necessary to make this all work and how in some cases -- due to limited resources -- we haven't yet achieved the level of integration we hope to achieve," Tegethoff said.
CHIME's Canner said it was significant to have representation at the event from the influential Ways and Means Committee, which is responsible for Medicare.
"The explanation of systems was helpful in understanding how IT protects privacy, helps to standardize care to prevent bad outcomes, and addresses a host of other patient safety issues," she said.
Mr. Bazzoli is CHIME senior director of communications.
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