Once the nearly exclusive domain of back-office hospital information technology professionals, the Healthcare Information and Management Systems Society conference is evolving into a showcase for ambulatory care initiatives.
A first-of-its kind study released last month at the San Diego conference says ambulatory computerized physician order entry systems could prevent 2 million adverse drug events and 130,000 life-threatening conditions each year. Widespread use of ACPOE systems would save the U.S. healthcare system $44 billion a year in reduced medication, radiology, laboratory and other costs, the study said.
Physician executives can expect dramatic improvements in error reduction and financial performance from a high-quality ACPOE system that will include many of the functions of an electronic medical records system, according to Blackford Middleton, M.D., chairman of the Center for Information Technology Leadership, the research group that authored the study.
Middleton, corporate director of clinical systems at Partners HealthCare System in Boston, says physician practice executives should plan to spend up to $29,000 per doctor to install a top-end ambulatory CPOE system and up to $12,000 a year to maintain it. He says physician leaders should aim high when picking an ACPOE system rather than settling for a simpler, less-costly electronic prescribing tool or other basic clinical system.
"Advanced systems produce superior returns," Middleton said during a HIMSS educational session. "Advanced ACPOE pays for itself within the first two years."
While the report says an advanced system can eliminate at least $10 in rejected claims per outpatient visit, Middleton does caution that this particular model is sensitive to capitation. Until more health insurers start paying physicians for quality, practices under fee-for-service contracts will share in only a small part of the overall savings from an ACPOE system, and payers will receive the bulk of the benefit, Middleton says.
The Leapfrog Group, a consortium of major healthcare purchasers, soon will be directing some of its attention toward outpatient care. Middleton, who has been working with Leapfrog to help implement its three current safety recommendations, all focused on hospital care, confirms that the fourth "leap," to be disclosed near the end of 2003, will indeed focus on ambulatory patient safety.
In the meantime, under a Leapfrog pilot program discussed at the HIMSS conference, primary care physicians soon may have financial incentives to refer patients to hospitals that meet certain quality criteria for high-risk treatments.
The incentive program is one of several quality promotion efforts the coalition will launch in coming months, according to Francois de Brantes, liaison to the Leapfrog Group for General Electric Co.
Leapfrog participants will announce "four or five" pilot programs aimed at implementing its acute care recommendations during the second quarter of the year, de Brantes says, while another will include financial incentives for hospitals to hire intensivists.
"If we're going to hold others accountable, we're going to have to hold ourselves accountable," he explains. "We need to add robust financial rewards for performance."
But a leading medical informaticist warns that some clinical technology intended to improve quality of acute care actually may exacerbate medication errors.
According to David Classen, M.D., associate professor of medicine at the University of Utah in Salt Lake City and vice president of Long Beach, Calif.-based First Consulting Group, new research due out later this year will suggest that hospitals may not be ready for automated order entry.
"CPOE can create new errors. It also can magnify errors," he told HIMSS attendees, explaining that an erroneous clinical pathway or incorrect dosing entered into an automated system can affect multiple patients.
Amicore, the physician practice IT venture between Microsoft, IBM Corp. and pharmaceutical giant Pfizer, will include InfoPath in the next generation of its software. The software will enable Amicore to integrate clinical, billing and practice management functions in one system.
The Medical Manager Health Systems division of WebMD Corp. also introduced an integrated software suite, called Intergy, for physician offices.
Those products and many others are being developed for multiple platforms, including desktop computers, personal digital assistants, the new TabletPC and wireless phones.
"We're basically device-agnostic," says Nick Beard, M.D., vice president for health informatics at IDX Systems Corp., echoing the message of many other EMR vendors.