Guest post by Kirk Larson, national CIO, healthcare, NetApp Inc.
As we start a new year, let’s take a moment and take stock of the past 12 months. Like an annual physical, it gives us a chance to take a pulse check on the industry and see what the next year has in store – the opportunities and the obstacles.
During 2015, we had the opportunity to chat candidly with CIOs, healthcare technology partners and healthcare providers to discuss the big questions affecting the industry:
— What are the big topics the industry will be focused on? — What changes do you see coming? — What new challenges lay ahead and what new technologies will help us overcome them?
Based on these discussions, here are some of the key trends healthcare CIOs can expect in 2016:
Electronic Health Record (EHR) Optimization
As healthcare organizations move beyond implementation phase of EHRs, CIOs and IT are refocusing their efforts towards enhancing care workflow and benefits realization by way of optimizing the IT infrastructure. Basically, the status quo on overspending on legacy hardware is no longer being tolerated.
While the high availability, performance and security requirements for IT infrastructure certainly aren’t lessening anytime soon, IT is feeling greater cost pressures to run EHRs more efficiently. As a result, organizations are looking to simplify IT operations for running on-premises data centers with improved data management solutions, with the end-goal of moving toward building their own private clouds.
In addition to greater cost efficiency, we are seeing a growing demand for increased agility of IT services. As such, organizations are looking to advanced analytics capabilities as a means of achieving greater responsiveness. But before they can reap the benefits of employing a population health management system, IT needs to shift from tired legacy IT environments to highly agile IT infrastructure.
Population Health Management
Population health management programs have long been used by healthcare insurers to increase wellness and decrease claims cost. Organizations leverage multiple data sources such as EHRs, pharmaceutical data, insurance claims, etc.; to enhance and preserve wellness, as well as, programs that anticipatory and pre-emptive in design.
Guest post by Robert Williams, MBA/PMP, CEO, goPMO, Inc.
I continue to view 2016 as a shakeup year in healthcare IT. We’ve spent the last five plus years coming to grips with the new normal of meaningful use, HIPAA and EMR adoption, integrated with the desire to transform the healthcare business model from volume to value. After the billions of dollars spent on electronic health records and hospital/provider acquisitions we see our customers looking around and asking how have we really benefited and what is still left to accomplish.
All politics is local
Our healthcare providers are realizing their clinical applications, specifically EMR vendors, are not going to resolve interoperability by themselves. When the interoperability group, CommonWell formed in 2013 much of the market believed the combination of such significant players (Cerner, Allscripts, McKesson, Athenahealth and others) would utilize their strength to accelerate interoperability across systems. Almost three years late CommonWell only has a dozen pilot sites in operation.
Evolving HL7 standards and a whole generation of software applications are allowing individul hospitals to take the task of interoperability away from traditional clinical applications and creating connectivity themselves.
Black Book’s survey published last month, stated that three out of every four hospitals with more than 300 beds are outsourcing IT solutions. Hospitals have been traditionally understaffed to meet the onslaught of federal requirements. Can they evolve into product deployment organizations as well? Across all the expertise they need within the organization? Most are saying no and searching out specialty services organizations to supplement their existing expertise and staff.
Are you going to eat that?
Patient engagement is on fire right now at the federal level (thank you meaningful use Stage 3), in investment dollars and within the provider community. But to truly manage hospital re-admissions and select chronic diseases (diabetes, obesity and congestive heart failure for example) providers need data and trend analysis on daily consumer behavior. The rise of wearable technology and the ability to capture data/analyze data from them will be a major focus going forward. These technologies will likely help to make us healthier but with a bit of big brother side affect.
Health IT’s most pressing issues may be so prevalent that they can’t be contained to a single post, as is obvious here, the third installment in the series detailing some of the biggest IT issues. There are differing opinions as to what the most important issues are, but there are many clear and overwhelming problems for the sector. Data, security, interoperability and compliance are some of the more obvious, according to the following experts, but those are not all, as you likely know and we’ll continue to see.
Here, we continue to offer the perspective of some of healthcare’s insiders who offer their opinions on health IT’s greatest problems and where we should be spending a good deal, if not most, of our focus. If you’d like to read the first installment in the series, go here: Health IT’s Most Pressing Issues and Health IT’s Most Pressing Issues (Part 2). Also, feel free to let us know if you agree with the following, or add what you think are some of the sector’s biggest boondoggles.
The healthcare industry has undoubtedly become a bigger target for security threats and data breaches in recent years and in my opinion that can be attributed in large part to the industry’s movement to virtualization and the cloud. By adopting these agile, effective and cost-effective modern technological trends, it also widens the network’s attack surface area, and in turn, raises the potential risk for security threats.
We actually conducted some research recently that addresses evolving security challenges, including those impacting the healthcare industry, with the introduction of cloud infrastructures. The issue is highlighted by the fact that the growing popularity of cloud adoption has been identified as one of the key reasons IT and security professionals (57 percent) find securing their networks more difficult today than two years ago.
Paul Brient, CEO, PatientKeeper, Inc. No industry on Earth has computerized its operations with a goal to reduce productivity and efficiency. That would be absurd. Yet we see countless articles and complaints by physicians about the fact that computerization of their workflows has made them less productive, less efficient and potentially less effective. An EHR is supposed to “automate and streamline the clinician’s workflow.” But does it really? Unfortunately, no. At least not yet. Impediments to using hospital EHRs demand attention because physicians are by far the most expensive and limited resource in the healthcare system. Hopefully, the next few years will bring about the innovation and new approaches necessary to make EHRs truly work for physicians. Otherwise, the $36 billion and the countless hours hospitals across the country have spent implementing electronic systems will have been squandered.
Email security is one of healthcare’s top IT issues, thanks, in part, to budget constraints. Many healthcare organizations have already allocated the majority of IT dollars to improving systems that manage electronic patient records in order to meet HIPAA compliance. As such, data security may fall to the wayside, leaving sensitive customer information vulnerable to sophisticated cyber-attacks that combine social engineering and spear-phishing to penetrate organizations’ networks and steal critical data. Most of the major data breaches that have occurred over the past year have been initiated by this type of email-based threat. The only defense against this level of attack is a layered approach to security, which has evolved beyond traditional email security solutions that may have been adequate a few years ago, but are no longer a match for highly-targeted spear-phishing attacks.
Dr. Rae Hayward, HCISPP, director of education and training at (ISC)²
Dr. Rae Hayward
According to the 2015 (ISC)² Global Information Security Workforce Study, global healthcare industry professionals identified the following top security threats as the most concerning: malware (77 percent), application vulnerabilities (74 percent), configuration mistakes/oversights (70 percent), mobile devices (69 percent) and faulty network/system configuration (65 percent). Also, customer privacy violations, damage to the organization’s reputation and breach of laws and regulations were ranked equally as top priorities for healthcare IT security professionals.
So what do these professionals believe will help to resolve these issues? Healthcare respondents believe that network monitoring and intelligence (76 percent), along with improved intrusion detection and prevention technologies (73 percent) are security technologies that will provide significant improvements to the security posture of their organizations. Other research shows that having a business continuity management plan involved in remediation efforts will help to reduce the costs associated with a breach. Having a formal incident response plan in place prior to any incident decreases the average cost of the data breach. A strong security posture decreases not only incidents, but also the loss of data when a breach occurs.
Guest post by Steve Tolle, chief strategy officer and president of iConnect Network Services, Merge Healthcare.
Sooner than later, payers will demand meaningful interoperability to determine the true cost of quality healthcare outcomes. While they may not have a preference for which electronic health record (EHR) platform a doctor or health system uses, they will understand that a platform’s ability to communicate with other EHR platforms will affect the cost and quality of the care provided.
Payers are already implementing bundled payments for some types of costly care, such as full hip replacements. Conventional assumptions aside, physician fees and facility charges are not the leading drivers of joint replacement cost variability. Instead, wide cost disparities frequently seen between Joint Replacement Procedure A and Joint Replacement Procedure B are the product of unpredictable charges for supplies, anesthesia, and medical imaging. When payers start bundling reimbursements for common procedures, risk will shift to providers who will be challenged to closely manage cost fluctuations. In preparation for this transition, healthcare organizations must proactively assess their imaging strategies to keep their business running smoothly, continue providing quality patient care, and ensure they maximize revenue for the services they deliver.
What Providers Must Evaluate
Medical imaging is a $100 billion industry that drives $300 billion in healthcare spending. It accounts for nearly eight percent of U.S. healthcare spending, according to the Journal of the American College of Radiology — a costly component of care that must be effectively addressed as the industry readies itself for the shift from volume to value-based reimbursement.
The U.S. Department of Health and Human Services recently set an ambitious goal that by 2016, 85 percent of healthcare payments will be tied to quality and value of care. Successful healthcare organizations will need to manage two key factors closely — appropriateness and efficiency.
CMS and private payers will increase their vigilance around quality measures such as readmission rates and unnecessary diagnostic imaging. Medically unnecessary or redundant imaging is already on Medicare’s radar, showing up in legislation that mandated decision support for imaging and extended the deadline for ICD-10 conversion. If providers begin to correct course now, downstream risk of lost revenue and decreased patient satisfaction can be mitigated, if not avoided.
Take Stock of Current Assets
To stay ahead of the curve, providers should evaluate all aspects of their image management programs. Many are looking for new solutions that simplify and digitize outdated, paper-based procedures for patient orders, automate insurance payment authorization, and move images from point A to point B in real time, regardless of file format.
Guest post by Num Pisutha-Arnond, managing partner, Curas, Inc.
Now that we are approaching the final stage of meaningful use, what has all of this regulation, incentives and penalties gotten us? The answer to that is unclear. Instead, what we are starting to see is a more introspective look at electronic health records. The real question has nothing to do with meaningful use, which was an externally mandated set of systems and requirements. Today, practices find themselves internally motivated to examine exactly what they would like to get out of this system that you have spent a lot of time, money and effort putting in. How can they improve operations, their finances, patient care and experience? What is the practice itself trying to accomplish? The answer to that varies significantly by specialty, practice size, geography, and your goals and priorities as they relate to your practice.
Because we’re already beginning to see life after meaningful use, and have been for the past 18 to 24 months, we can provide insight into some common goals and how practices are moving beyond meaningful use to achieve what cannot be measured by the criteria set forth by CMS.
The primary goals that we have experienced with our clients can be broken down into a few categories:
Better patient care
Better patient experience
Improved practice profitability
Provider and staff quality of life
Better patient care
Items related to this category often include the creation of patient dashboards/reports and patient recalls/campaigns to stay engaged with patients. However, the most effective, and often tougher initiative to implement, is a point of care system that lets providers and staff know when a patient should possibly have a certain test or procedure performed without having to search for data across different progress notes or screens.
Better patient experience
Most practices and vendors immediately jump to patient portals, kiosks and apps when discussing these goals. However, these are just a few of the tools that can be used to improve patient experience. In some cases, these tools may actually not enhance the experience if they are lacking in usability or if they are deployed in an uncoordinated manner. What is needed is a look at the overall patient experience from when they first call to the practice to when they have left the practice and need to be contacted by the practice. In some cases, the existing software and tools that have been implemented will work if the process is refined. In other cases, new software and tools may be needed. In others, you might even consider eliminating some of the technology to make a better experience for the patient.
Guest post by Donald M. Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University; and Thanh Tran, CEO, Zoeticx, Inc.
The ECRI Institute released in May a survey outlining the top 10 safety concerns for healthcare organizations in 2015. The second highest concern is incorrect or missing data in EHRs and other health IT systems.
HIEs? The latest Black Book survey in the U.S. finds that 90 percent of hospitals and 94 percent of independent physicians don’t trust the business model of public HIEs and have concerns over how much of the cost payers will be fronting, causing a contraction in the HIE market. Even the ONC and medical industry are at odds on how to address the interoperability issue. The ONC does not even mention middleware in any of its plans.
Even HL7 does not provide the seamless connection of middleware and is only capable of connecting one medical facility to another, requiring specific end point interfaces to even do that. For every additional facility, a customized interface must be built. At the end of the day, HL7 is really a point-to-point customized interface requiring extra steps. A middleware platform does not tie developers to specific hospitals or EMRs and allows universal access.
Meanwhile, yet another survey cites the tragedy of a lack of interoperability. A new survey of nurses nationwide, taken by the Gary and Mary West Health Institute, find that some 60 percent of registered nurses say medical errors could significantly decrease if hospital medical devices were coordinated and interoperable. Also, 74 percent of these nurses agreed that it is burdensome to coordinate the data collected by medical devices and 93 percent agreed that medical devices should be able to seamlessly share data with one another automatically.
Half of them claim they actually witness medical mistakes because of lack of interoperability of these devices. Some 46 percent of RN respondents also noted that when it comes to manual transcription from one device to another, an error is “extremely” or “very likely to occur.”
From a cost perspective, West Health Institute officials estimate that a connected, fully interoperable health system could save a potential $30 billion each year by reducing transcription errors, manual data entry and redundant tests. Meanwhile physicians and surgeons struggle with interoperability on a daily basis.
According to data published on HealthIT.gov, 173 health IT vendors are supplying certified EHR products to more than 4,500 hospitals. Despite wide penetration of EHR’s in hospitals, clinics and physician offices, access to patient information between systems continues to plaque our healthcare system.
Guest post by Shannon Snowden, senior technical marketing architect, Zerto.
Electronic health records (EHR) are the tie that binds together the patient with the caregivers. What happens when an extended outage or disaster happens? Caregivers still have to administer treatments regardless if the systems are online.
The longer the outage, the greater the negative impact to the quality of the end product or service. In the healthcare business, it is unacceptable. Every manually tracked record has to be added back into the EHR when it is available once again.
A big concern is that the manual records often get summarized with many of the details those electronic healthcare systems track are missing. These knowledge gaps ultimately could diminish the quality of patient care.
A contributing factor to the difficulty in finding a good disaster recovery solution is the technology necessary to support healthcare information systems (HIS) are complex, involve multiple servers that are tightly integrated and are quite unique from the perspective that the application vendor remains very involved with the customer on an ongoing basis.
This is the challenge faced by healthcare organization CIO/CTOs, IT directors and managers. How do you provide a sound business continuity solution that enables nearly no interruption in patient services is easy to manage and is within a realistic budget? What should be considered requirements for a healthcare information system disaster recovery solution?
Here is what to look for in a disaster recovery solution:
Guest post by Alexandra Sewell, executive director, enterprise marketing, Comcast Business.
Meaningful use is one of the largest drivers of healthcare IT, with the potential for far-reaching effects. Many healthcare organizations are well on their way to achieving meaningful use, working through related cost, training and resource challenges.
But there is still work to be done. Meaningful use can require significant network infrastructure investment to support electronic health records (EHRs) and other technologies. At the same time, budgets are shrinking, so providers must be strategic about how they allocate IT dollars.
Improving Patient Outcomes
EHRs give doctors a complete view of the patient — from demographics and vital signs to medications, allergies and more. EHRs are a central component to complying with meaningful use Stage 1 requirements and help doctors easily view and transmit records, which can lead to more accurate patient diagnosis and treatment.
Hospitals with EHR systems can better capture data regarding patients’ co-morbidities and other risks. This helps clinicians manage patients, resulting in more positive clinical outcomes and improving mortality rates for heart attack, respiratory failure, and lower intestine surgery. EHRs can help improve the overall quality of patient care.
Picture Archiving and Communication System (PACS) technology provides economical storage and convenient access to a range of images from multiple imaging devices, transmitting them digitally and eliminating the need to manually file, retrieve or transport film jackets.
To comply with Stage 2 of meaningful use, healthcare providers must offer patients the ability to view, transmit, and download their health information. And while not explicitly mandated by meaningful use core objectives, many organizations are integrating their PACS and EHR systems so images, such as MRIs and CT scans, can be shared between physicians and with patients through patient portals. However, the size and volume of these imaging files place stress on hospital networks, creating data capacity and data center connectivity issues.
Information Technology holds the promise to spur innovation in the healthcare industry. However, if IT investment is focused on simply meeting mandates and not on driving a specific differentiated business objective, then it begins to look a lot like what we are seeing today – extensive capital and resources spent on implementing and supporting IT initiatives that, so far, have provided little to no financial returns. But this does not mean that the promise of IT is empty. Instead, it calls attention to the need to look at IT not as a way to “check the box” and either collect federal incentive dollars or avoid eventual penalties, but rather as a key tool to remain competitive in the market as well as provide quality care.
In light of recent federal mandates under meaningful use regarding the implementation of electronic health records, many EHR vendors are now propagating the idea that their software is not only compliant with regulatory statutes, but is also a singular comprehensive and strategic IT investment. However, this is just half the truth.
Under the pressures of time and expiring incentives, many healthcare executives have leapt after EHR investments without understanding the real strategic reasons for making IT investments for their enterprises. Otherwise savvy and well-meaning healthcare leaders are allowing EHR vendors to convince them that an EHR is the answer to their business needs and will provide them with an edge over competitors in the market. In reality, EHRs fail to provide a competitive advantage once most or all hospitals in a geographic market have implemented the tool. How can an organization claim it is superior in IT if it is operating the same systems as every other provider in the market? EHRs must be approached as a one-time operational input or business asset similar to hospital equipment and not the core component of a broader IT solution needed to support a sustainable business strategy. As with most investments, it is what you do with it which matters, not that you simply own it.
According to Patient-Centered Primary Care Collaborative, the patient-centered medical home (PCMH) is a “model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety.” PCMHs power business and clinical processes by using clinical decision support tools to connect patients with members of their healthcare team to improve both the patients’ and the providers’ experience of care. This coordination encourages a stronger physician-patient relationship, leading to better care delivery, more involved and engaged patients and reduced avoidable costs. According to the National Committee for Quality Assurance (NCQA), these models are “transforming primary care practices into what patients want, focusing on patients themselves and all of their healthcare needs. They also are foundations for a healthcare system that gives more value by achieving the ‘triple aim’ of better quality, experience and cost.”
The NCQA recognizes over 10 percent of U.S. primary care practices as patient-centered medical homes. In order to be recognized by the NCQA, these primary care practices must offer access both afterhours and online, allowing patients to receive care when and where they need it. They work with patients to make treatment decisions based on individual preferences and help patients engage in their own health. The practice as a whole works as a team to coordinate care from other providers and community resources to maximize efficiency. Additionally, PCMHs focus on preventive care and the management of chronic conditions to prevent complications and emergencies.