Changes to Louisiana's healthcare system can promote standardized care for patients

Louisiana's healthcare is described in terms of "pre-" and "post-" Katrina, even four years after the storm.

Before Hurricane Katrina, Louisiana's healthcare system was strained, with a quarter of the population living below the poverty line and an estimated 20 percent uninsured. Healthcare for this population was provided through the state-run Charity Hospital and financed through Medicaid DSH (Disproportionate Share Hospital) dollars.

Subsequently, New Orleans' healthcare system was ravaged. Hurricane Rita, which hit shortly after, delayed any progress in recovery. The impact of the storms on the health system and in health services has been far and wide -- the displacement of hundreds of thousands of people has made it difficult for them to get healthcare, important health records have been destroyed and residents continue to face both the physical and mental consequences of both storms.

As a result of these back-to-back events, almost 100 health agencies in the New Orleans area were either flooded or destroyed (home health providers included), serving a combined 21,000 home health patients. Agencies in outlying states, such as Mississippi and Alabama, were also affected by the storm -- both physically with structural damage and also in terms of staffing and space, as they took in displaced patients.

"Like many other industries, the home health agencies in New Orleans were dealt a huge blow post-storms," said Tara Mondock, Group Vice President, IVANS, a healthcare information technology services company, stating that the destruction of infrastructure has had an overwhelming effect on the workforce.

While the state continues in its recovery efforts, a significant number of nursing homes and hospitals remain either closed or operating on a shoestring and many elderly and disabled people are being sent to home health agencies, which, according to the HomeCare Association of Louisiana, are often operating at capacity. As of January 2007, the Brooking's Institution's Katrina Index reported that only 52 percent of state-licensed hospital beds were in operation.

"New Orleans continues to struggle with staff shortages across the board," said Mondock, "putting a continuous strain on the systems." One solution to alleviate the burden on the healthcare workers would be the implementation of far-reaching health information technology systems and electronic health records (EHRs). The Louisiana Recovery Authority has been working diligently to develop a blueprint for an affordable, high-quality healthcare system that will put systems in place for the future. One of their recommendations is a statewide digital system that will serve as a backbone.

"EHR systems increase physician efficiency and reduce costs, as well as promote standardization of care," explained Mondock. "Sadly, Katrina is a severe example that makes the case for them." Paper medical records, she continued, that were destroyed can never be replaced. From a provider perspective, it gives all the core information about a patient -- no matter where the patient is and for both patients and providers, it saves valuable cost and time.

A recent survey of more than 500 healthcare providers conducted by IVANS on the issue of healthcare reform indicated that all is not cut and dry. While respondents, specifically the more than 300 home healthcare and nursing home organizations, believe in the importance of healthcare policy, they are concerned about the toll it will have on patients and providers.

The survey, which focused on healthcare reform and technology, showed providers are overwhelmingly hopeful that changes to health information technology could have a far-reaching impact -- lowering the cost and improving efficiency of care.

Among the findings:

-- Nearly 70 percent of home healthcare and nursing home organizations say that electronic health records (EHRs) will have a positive impact on their day-to-day business (a fact echoed by the National Coordinator for Health Information Technology, which estimates that the healthcare system will save an estimated $140 billion/year if this technology is adopted) and -- 56 percent of respondents have begun to or plan to implement EHRs within the next year -- More than half (52 percent) of providers doubt that stimulus money will successfully encourage adoption of healthcare information technology -- Providers support the use of Health Information Technology to increase quality of care and improve efficiencies -- Almost three quarters (72 percent) believe a pay-for-performance model could lead to improved patient outcomes.

One example of implementation in Louisiana is a statewide communications network, known as LaRHIX, which will ideally support health information technology initiatives in rural areas. The portal operates over the Internet and enables healthcare professionals to access medical records from any provider database that is connected to the network.

"This system is a great example of a step to better an already put-upon system," said Mondock. "To have access of medical records and share information is the essential next step in ensuring efficiency and reducing costs, but not sacrificing the quality of care for our patients. Tests don't have to be repeated and we have access to real-time diagnosis and eligibility."

Case in point, one of the major sources of rapid growth in healthcare costs comes from medical imaging, according to the U.S. Government, citing Medicare Part B spending on imaging rose from $6.80 billion in 2000 to 14.11 billion in 2006. "Access to a patient's images on an EHR is an effective way to avoid the costs and time to duplicate an effort," said Mondock. "Another high cost in healthcare is provider payment," she continued. "Everything from providers not getting paid for services to the printing and mailing of checks." Americans can save an estimated $11 billion annually if medical payment transactions in the U.S. were handled electronically via direct deposit, she explained.