HIMSS 2012 – REC of NH, David Delano

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Dr. Howard Rollins, EHRtv AIMS specialist and medical consultant, interviews David Delano, Project Director of REC of NH.

Category: HIMSS12, Tradeshows
Date: March 24, 2012
Views:2,819 views

Howard Rollins: I am Dr. Howard Rollins with EHRtv. I am at HIMSS 2012 in Las Vegas and I have the pleasure of speaking to Mr. David Delano who is the Project Director for the Mass eHealth Collaborative. Dave thanks for being here with us.

David Delano: Sure my pleasure.

Howard Rollins: The first question I have is why are you here? What are you doing and why are you here?

David Delano: Right so the Mass eHealth Collaborative is a consortium of Quasi Public, Private Services that we offer to states, to public and private organizations that are implementing electronic medical records.

Howard Rollins: Let me stop for one minute. What do you mean by Quasi-Public, Private?

David Delano: Well we do a lot of work with state agencies. So for, New Hampshire and Massachusetts, we are working with the both governmental sides of the state HIE efforts there and helping them put together their strategy for Health Information Exchange across the states that are implementing those. So we get involved in a lot of public and grant-related activities. So that’s why I said Quasi.

Howard Rollins: I see. So what exactly, let’s be a little more specific.

David Delano: Sure.

Howard Rollins: Okay tell me exactly about…

David Delano: All right. So we have the Regional Extension Center in New Hampshire.

Howard Rollins: That’s what you mean by REC, Regional Extension Center?

David Delano: Correct, correct and the REC provides services to physicians and their practices in helping them go to electronic medical records. So we support their selection of electronic medical records, the adoption and use of those.

Howard Rollins: Do they contact you or you reach out to the physicians?

David Delano: We do both. We actually have over 1000 physicians enrolled in New Hampshire in the REC program and so we do outreach to them or they contact us and then we essentially enroll them in our program we go out and assist them with all of those things we talked about and it’s a really great program.

Howard Rollins: And what kind of market share if you will – market share, or penetration is there right now in the EHR business?

David Delano: Yeah so nationally you keep hearing numbers around like about 16% to 17% was about – what about a year ago. Now you hear numbers like 25%, 30%, somewhere in that range. We are actually in New Hampshire leading in that in terms of stage II adoption, there is three stages of the REC program. There is the essentially signing up or selecting an EMR, implementation of that and going to add a station which is the meeting meaningful use measures. So we are leading the Regional Extension Center programs in the most providers that are at that level of adoption in the state, so…

Howard Rollins: What do you think it is?

David Delano: It’s an interesting thing, I don’t know. I think there has been a lot of EMR penetration already in New Hampshire. So we kind of had a leg up there when we started. So that was a good thing but we also think that there is just a culture there of adopting technology and the practices a lot of them are affiliated with other large health institutions so they are getting support from there as well.

Howard Rollins: Do you think does the penetration go across all specialties or they are somewhat like family physicians and in turn, is that a more aggressive about adopting EMRs?

David Delano: Yeah no it’s actually started more with – particularly in New Hampshire with the Primary Care nonspecialty market mainly because they get these REC support services but now we are engaging more – we are seeing a lot more engagement too now with the subspecialties and specialties who are interested in meaningful use and other things but don’t directly benefit from those REC services. So they are in now contacting us for help as well.

Howard Rollins: So where do you see the future going? Are we on an exponential curve now?

David Delano: I think so. I mean, I think we are kind of getting over that proverbial “hump” if you will in terms of the market penetration of EHRs and EMRs mainly because a, meaningful use is driving them and I think where the future is going here is around more accountable care if you will use that word.

Howard Rollins: Yeah.

David Delano: We are involved in a pioneer ACL project now in the Boston area. We are providing clinical quality measures for that group of physicians there. So there is a lot of activity moving in that direction and so I think EMRs are the facilitator or the tool to help us get there.

Howard Rollins: Do you think cost was a driving factor in holding things back or was it more of just being a little insecure about change of workflow?

David Delano: Yeah so that’s really a good question. I mean everything at the end of the day is about cost and equation and value and all of that sort of things. So I think that was definitely a factor in that but it’s really I think a shifting tide across all those things we just said you know. Where is the ultimate reimbursement model going here, we don’t know yet, I mean we think stage II meaningful use should be coming out very shortly which should help clarify some of the future directions of where this is all going at least for the next stage but so I think it’s a combination of regulatory change, the need to improve healthcare, the cost factors that were holding people back from adopting technology and the support services. You know, we are actually now helping people do this whereas before there really wasn’t any support for these practices and providers. Now they are getting some support.

Howard Rollins: Do you think with ICD-10, it really accelerates things or does it hurt the flow. How is that going to affect them?

David Delano: Yeah so I think I have two sides to that. The side of me that services the REC side I think is going to make it more challenging because we are going to have to reeducate, retrain and essentially go to a higher level of coding and adoption of that standard. So that side really for me it makes it feel like it’s more burdensome, more work, more burden on the practices and providers but then the quality measurement side to me on the quality data center work that we do says we really need more discrete, good quality clinical data in order to help drive these quality measurements and outcomes we are trying to get to so there is both sides to that argument and I think you know it’s going to be a challenge but we have to get there.

Howard Rollins: You had mentioned earlier standards that you recently discovered were fell short of where you think they should be. Could you tell me a little about that?

David Delano: Right, yeah so absolutely, yeah. In this project we did here at the interoperability showcase at HIMSS, we discovered that there are really three things that are driving differences in how quality measurements across body measurements are produced, the three areas that we discovered really are three, sort of fall into the category of interpreting the current standards in your own way. So for example, what is a person’s age, if somebody says you are between age 18 and 75, would that stop on the person’s 75th birthday because the day after that, they are 75.1 or 75.2 and so there is a whole interpretation of the standards issue associated with that. There is also the code sets in the standardized code sets that aren’t being universally used consistently across all EMRs to generate the good quality outcome data that we need and really the third part of this is how we look at that lifetime record for a patient whether that be a single view, or single episode of a life time record or a series of encounters or slices of time that we can associate clinical events with more accurately. So there is this whole how do you interpret what it is we are trying to measure and then getting it out consistently and repeatedly the same way and so that’s a really a big challenge as we go forward with clinical quality measurement.

Howard Rollins: Dave you mentioned the term interoperability.

David Delano: Right.

Howard Rollins: I would assume – I would say that many doctors have not even heard that word before.

David Delano: Right.

Howard Rollins: And interfacing was the word that more may have heard of. Tell me the difference and tell me the significance?

David Delano: Right so when you think of interfacing which should we go as use the word the I word because it raises kind of a difficult connotation because interfacing essentially implies you have two systems that are connected together with an interface.

Howard Rollins: Right.

David Delano: The interface exchanges information between the two. Interoperability is more about making that a part of the workflow and a part of the exchange process within sort of native within the environment, within the EMR, within the Health Information Exchange so that interoperability means the ability to not only share data back and forth but to actually use that data in a meaningful way between the two systems and to have it be an actionable part of the workflow. So interoperability might be sending a real-time clinical summary to the ED where then they are reacting and responding to that in a real-time manner.

Howard Rollins: So this is the term we are going to be hearing about for a long time in the future?

David Delano: I think so yeah absolutely, interoperability.

Howard Rollins: Hey thank you very much.

David Delano: Howard thank you, thank you.

Howard Rollins: David Delano, Mass eHealth Collaborative.

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