We live in a world where medical errors are the third leading cause of death behind cancer and cardiac disease, leading to more than 200,000 preventable deaths every year. We have an aging population growing at an unprecedented rate: 8.5 percent of people worldwide (617 million) are aged 65 and older, and this percentage is projected to jump to nearly 17 percent (1.6 billion) by 2050, leading to an anticipated physician shortage of more than 50,000 by 2025. On top of all of this, healthcare costs are projected to increase to over 25 percent of GDP in the United States by 2025. The convergence of these events is pushing the entire industry to begin leveraging technology more than it has in the past.
Many of these challenges can be remedied by leveraging Industrial IoT (IIoT) technology that’s been proven to solve similar challenges in other industries. Could an interoperable, connected healthcare platform that applies the principles of an IIoT connectivity architecture to share data throughout the healthcare system be the cure for our ailing healthcare system?
West Health, now the Center for Medical Interoperability, seems to think so. In 2013 they published a report showing how an interoperable, connected healthcare system could provide nearly $30 billion in industry savings while improving patient outcomes in the process. These connected healthcare platforms provide the foundation for innovation that is needed to make a meaningful data-driven change in healthcare. It’s these platforms that open the door to application developers everywhere to create modality-specific applications using artificial intelligence and machine learning.
So what exactly is a connected health platform and how does it provide a foundation for transformational change in healthcare? First, a connected health platform consists of hardware (gateways and servers) and embedded software components that are designed to take all of the data from any medical device (clinical or remote) and convert the data in a single usable format that gives providers access to a complete data set.
This connected platform will provide a variety of user interfaces, analytics and clinical applications to help users throughout the healthcare ecosystem distill value from this newly-gathered data. The applications range from the early detection of sepsis, to predicting cardiac arrest, to providing business analytics like bed and device utilization. The connected health platform will become the center of an ecosystem for further application development, similar to that of an online app store – but with built-in medical-grade safety and security. The connected health platform must ensure data security and patient privacy by aligning to guidance provided by the FDA on cybersecurity, and meeting the standards defined by HIPAA.
However, these connected health platforms are only as effective as the data they capture, which is determined by the connectivity frameworks they are built upon. Many of the currently deployed platforms are not platforms at all, but a collection of disparate systems that provide silos of individual device data.
These legacy systems have been built using internally-developed, proprietary, message-based communication technology. As the first step towards the development of a connected health platform, modern web services-based communication has been deployed on top of the legacy technology to begin integrating all of the disparate data streams via onsite data centers or the cloud. Although this is a step in the right direction, these platforms are far from complete. Because of the legacy communications infrastructure they are built upon, they are only able to aggregate a portion of the data making these systems a poor fit for true near-patient, real-time clinical decision support – the key to efficiently providing improved patient outcomes.
The Industrial Internet Consortium (IIC) recognized that the healthcare industry, along with many other “mission-critical” industries, was experiencing a similar set of connectivity and data integration challenges, and thus was not realizing the true benefit of the IIoT. In 2017, they set out to provide recommendations for the fundamental connectivity and security requirements of next generation IIoT systems. Its Industrial Internet Connectivity Framework document (IICF) recommends the Data Distribution Service (DDS) standard as the ideal framework for near patient, real-time connected health platform development. DDS provides a highly reliable, secure, real-time interoperable connectivity platform and is proven in other mission-critical environments, such as autonomous vehicles, naval ships and wind farms. These systems all rely on real-time data that allows medical device companies to design a connected health platform for today and the future without the burden of a less performant message-based architecture.
DDS provides a level of reliability, security and interoperable performance that cannot be matched with any other currently available, standards-based technology. By working with standards-based technology like DDS, healthcare developers can develop systems faster, with lower development and maintenance costs. Using an advanced connectivity software framework allows the connected healthcare platform developers to better focus their core competencies, and their customers’ requirements, clinical workflow, analytics and diagnosis.
The next 10 years will be transformational for the healthcare industry. Innovation will be moving at an unprecedented pace. Big tech, medical device vendors, payers and providers will be racing to develop or leverage new technology to better utilize data to improve patient outcomes, lower the cost of care and run more efficient operations. The connected healthcare platform is the future of the healthcare market. Those who embrace this trend and get to market first will transform the industry and establish a model for high-value, lower cost care for generations to come.
HIMSS organizers, in preparation of the annual conference and trade show, and as a way to rally attendees around several trending topics for the coming event, are once again asking the healthcare community how it feels about several key issues that are likely to resonate. As is often the case with this ongoing experiment, the folks in my position — those with a venue to voice their opinions who tell the rest of us what they think — pontificate on the potential impact of these trends.
Certainly, some of my fellow journalists are far better qualified than I to answer the questions posed by HIMSS with any level of authority. Therefore, I’ve given my small microphone to readers of this site so they can voice their opinions of the topics that conference goers are likely to hear about dozens of time while in Chicago.
This year HIMSS is asking what we feel will be the future of: the connected healthcare system, big data, security, innovation and patient engagement. Today, here, we focus on the future of the connected healthcare system, and what several insiders believe that future to be.
With that, enjoy and let me know if you agree with the following thoughts. If not, why; what’s missing?
Tom Bizzaro, vice president of health policy, First Databank
Tom Bizzaro
We’re hoping that the electronic health records (EHR) interoperability movement follows a trajectory similar to that of e-prescribing. To start, as an industry, we have to universally acknowledge the value of interoperability within healthcare IT systems. Indeed, sharing data across systems can help to improve care quality and efficiency in the country’s health system and lead to success of value-based reimbursement models. However, all players – providers, payers, patients and vendors alike – need to truly embrace the value EHR interoperability, putting it above any proprietary concerns.
Then, we need to get to work. We must continue to develop and implement a wide range of standards and vocabularies. Through these, we will ensure that our data is in synch and that systems will always be speaking the same language. Perhaps most important, we need a National Patient Identifier, which will make it possible to match information to specific patients as they traverse the health system. And, while it might seem like doing all this work will take a long time, if we roll up our sleeves and do what’s required, the EHR interoperability story will be on its way to its own happy ending soon enough.
Jonathan Isaacs, executive vice president and general manager, surgery solutions, SourceMedical
Jonathan Issacs
It’s 3:00 a.m. and you wake up with an acute pain in your side that won’t go away — you head to the ER. The CT scan shows nothing — you head to the GI specialist. The doctor says to get an endoscopy — you head to the ASC. The endoscopy says you have a chronic condition that will need to be managed by you, your PCP, and even more specialists. Where does all that data live? Everywhere!
It’s a changing world out there. From cancer centers to freestanding Emergency Departments, healthcare organizations must deliver quality care at lower prices. But information collected at different points can fall through the cracks, putting the patient at risk. That’s why data interoperability is a critical issue.
The solution is not to put every entity in the healthcare value chain on the same closed, monolithic EHR that tries to do everything. We have seen time and again what happens when innovation is stifled and vendors become “too big to fail.” But by embracing connectivity standards, providers and patients alike can leverage best-in-class tools purposely built for specific treatments and outcomes. The easier it is, the higher the likelihood of success. And isn’t that the whole point?
Mobile devices are completely ingrained in the fabric of our daily lives – from personal use to business – throughout the world.
The healthcare industry, usually resistant to the whims of technology trends, has been a fast and significant adopter of mobile devices. Apple’s introduction of the iPad appears to have been a watershed that brought healthcare IT into the 21st century. Besides improved efficiency in communication and administrative functions, clinicians found the devices much more practical to incorporate to patient interactions – from consultation to education. Now mobile devices have become almost indispensable in the daily care of patients. Physicians use smart phones and tablets wherever they review patient records, receive updates or alerts by secure text messaging and coordinate care among other clinicians. Care professionals are connected to health information like never before.
Telehealth has “connected” patients and physicians for decades in an attempt to deliver proactive healthcare, but mobile devices and cloud-based technologies are making remote healthcare more practical. Still, we are just scratching the surface as to what a “connected healthcare system” can look like. Despite strides, we still need to tie it all together: patients, physicians, devices, data, analytics, decision support, monitoring services and education – to achieve the best outcomes for our patients.
A connected patient is more compliant with a better chance to attain better outcomes. A connected provider has access to better information to make better decisions. The common goal is to keep the patient out of the hospital, lower costs, reduce the strain on an already strained healthcare system and provide better outcomes. How we implement the goal of a connected healthcare system is the challenge.
In assessing how to best utilize mobile technology with patients and providers, my belief is that one solution doesn’t fit all. We must align the right technology with the right patients. Smart phones and tablets with complex apps and expensive data plans may be common in demographic groups that may skew younger, or those with higher technical literacy and dexterity and more disposable income. Simpler technology using month-to-month or prepaid service plans may better suit seniors and those with limited and fixed incomes. Meaningful change will come faster by focusing on the 15 percent of the population that consumes 80 percent of healthcare costs. This segment traditionally includes the elderly and indigent, Medicare/Medicaid population. This group doesn’t overwhelmingly consume the “latest and greatest” devices with the hottest apps and seamless connectivity – 4G, Bluetooth, WiFi and syncing to the cloud is not reality. We must be realistic when we propose solutions to address something as important as the delivery of patient care, providing the right technology to meet the needs of the people using it. Acquiring the right data, at the right time, and right cost, to achieve the right (better) outcome for the patient.
A patient’s right to the privacy of their health records seems obvious, but some of the benefits of connected health will only be achieved if this right is qualified and perhaps compromised. Assuming the twin goals of maximizing both personal and public health, there can be no absolute rights of privacy or ownership in personal health data.
The tools of connected health make it possible to determine the efficacy and safety of diagnostic and therapeutic devices and services in the real world. This can serve as the basis for a learning health care system that continuously improves its services and outcomes. Today it takes between 15 and 17 years for the medical community to fully embrace better approaches.[1]
Traditional privacy and ownership rights of health data stand in the way of these benefits. An obvious example of the problem arises where an antibiotic drug taken for an infectious and dangerous disease is not effective. What if a diagnostic device is unreliable? Does the patient have an absolute right to privacy in these situations? What obligation does that patient and her provider have to other individuals who are at risk and to the system that is paying for ineffective services?
There has been a lot of discussion recently in regard to the ownership of patient health data in the electronic health records of providers. The issues of ownership and privacy are overlapping considerations in determining the answer to these questions.
