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Weekly UpdatesIn decades past, physicians only needed a handful of items in their black bags: a stethoscope, thermometer, blood pressure cuff, reflex hammer, otoscope, prescription pad, and a handful of supplies were all that was required. Today, an Internet-capable PDA, Smartphone or Tablet PC may be in there as well as doctors turn to technology to coordinate--and improve--their patients' health care.
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Not only is health information technology, or HIT, becoming part of our health care lexicon, electronic health records and e-prescribing are buzz words that are reverberating in the halls of Congress as well as in state legislatures across the nation as they debate what to do about health care. And, with the inauguration of President Obama, health information technology has emerged as one of the essential ingredients of a reformed health care system.
Alabama has long been ahead of the curve when it comes to health information technology. More than two years ago, the Alabama Medicaid Agency won a $7.6 million federal Medicaid transformation grant to create a new, statewide electronic health information system that will save money, reduce duplication and most importantly, fill in gaps that lead to better patient care.
The effort, known as Together for Quality, is a three-part initiative that has attracted national attention for its ability to bring a diverse group of partners together to design and implement the innovative system. There are three components: The QTool electronic health record, Q4U, a care management program for patients with chronic diseases such as asthma or diabetes, and Q-X, an electronic system for state agencies to exchange data on shared clients.
QTool is being pilot-tested in nine Alabama counties where physicians are discovering the value of having Medicaid and Blue Cross/Blue Shield claims information on past doctor visits, hospital stays, tests and medications when examining their Medicaid patients. E-prescribing, the ability to electronically send a patient's prescription to the pharmacy, was added in March. More features will be added in the upcoming months by Medicaid and Affiliated Computer Services Inc., which assisted in developing the web-based tool.
Alabama's foresight in embracing technology to deliver better health care more economically will be a tremendous asset as we prepare to compete for health information technology grant funds associated with the American Recovery and Reinvestment Act of 2009.
The ARRA is expected to provide substantial funding--more than $20 billion--for the development and adoption of HIT. The largest allocation--some $17 billion--is for incentive payments through the Medicare and Medicaid systems to encourage providers and hospitals to implement electronic medical record systems. Gov. Bob Riley has asked the Alabama Medicaid Agency to serve as the lead for health information technology activities related to ARRA grants. This effort is not limited to just Medicaid. Our role will be to spearhead collaborative efforts related to HIT grants, coordinate federal grant requests and work closely with the state's coordinator for all federal stimulus activities to track and manage HIT funds that will be available to the state. As information becomes available, we will post it on our web site at www.medicaid.alabama.gov
A lot of people think technology is impersonal. But a story I heard recently is an example of how technology can be very personal ... and very important.
The child had been to the emergency room for suspected appendicitis, but had been sent home with a clean bill of health. Several months later, the patient went for a visit to his regular doctor. The doctor checked the QTool electronic health record and was surprised to see a diagnosis of renal cysts.
The doctor told me that the ER had sent a report that the patient's appendix and gallbladder were OK, but the actual ultrasound report was not included. He requested the ultrasound report from the ER. Sure enough, the child was noted to have multiple renal cysts. The parents had not been told about that at the ER or told to follow up about it and it was not documented in the report that the ER sent to the doctor, so it would have just fallen through the cracks if the doctor had not seen it in the child's QTool electronic health record.
The days when you had one doctor who knew everything about you has given way to a complex health care environment with multiple providers, numerous procedures and thousands of medications with unfamiliar names. Reports from specialists may be lost or delayed. Patients may forget medicines other doctors have prescribed. In the aftermath of a hurricane or other emergency, patients may report incorrect or incomplete information--a critical lesson learned from Hurricane Katrina.
Health information technology is a new tool that can help us transform our medical system from one that is often fragmented and process-oriented to one that is coordinated, patient-centered and cost-efficient. When we do this, we help Medicaid recipients and all patients lead healthier lives by preventing problems, reducing duplication and creating an environment where quality health care can flourish.
Carol Steckel is commissioner of the Alabama Medicaid Agency and chair of the National Association of State Medicaid Directors, an APHSA affiliate.
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