Testifying before the Senate Committee on Health, Education, Labor & Pensions (HELP), DirectTrust president and CEO David C. Kibbe, MD MBA, urged the federal government to take action to help overcome the problems impeding the sharing of health information between and among parties authorized to access electronic health data, commonly referred to as “information blocking.”
David Kibbe
“While the responsibility for assuring secure interoperable exchange resides primarily with the health care provider organizations, and not with the EHR (electronic health record) vendors nor the government, I strongly believe there is a role for government to encourage and incentivize collaborative and interoperable health information exchange,” testified Dr. Kibbe, one of the nation’s foremost authorities on health information exchange security issues. Dr. Kibbe’s organization, DirectTrust, is a health care industry alliance created by and for participants in the Direct exchange network used for secure, interoperable exchange of health information.
Dr. Kibbe testified at a full Senate HELP committee hearing titled “Achieving the Promise of Health Information Technology: Information Blocking and Potential Solutions. During his testimony, Dr. Kibbe enumerated the problems with information blocking and offered suggestions to help improve upon the current situation in the near-term. Among the many actions Dr. Kibbe suggests the government take to help overcome information blocking include:
Continue to shed light on these problems, and work with trade groups, standards and policies organizations, and others to set expectations for interoperability of EHRs and other applications certified as interoperable, especially those that have been federally subsidized within the meaningful use programs.
Bring better and improved EHR certification processes forward beyond the testing laboratory so that the utility and usability of interoperability features of ONC certified EHR products in the field becomes part of the public record, and can be used in purchasing decisions. Collaboration and partnership with non-profit trade groups to achieve this goal would be advisable.
Accelerate federal agency use of and demand for open, standards-based interoperable HIE (health information exchange) with private sector providers and provider organizations, thereby removing reliance on paper-based mail, fax, e-fax and courier for these federal programs.
Examples include Veterans Health Administration referrals to and from private sector medical practices and hospitals; Veterans Benefits Administration health information exchanges with private sector medical practices and hospitals; the use by Medicare, Medicaid, and state agencies of interoperable HIE for communications with private sector providers and provider organizations for limitation of fraud, payment adjudication, claims attachments requests, and other administrative transactions now done via fax and mail.
Continue to tie more robust ONC EHR certification and use of certified EHR technology to participation in value-based purchasing programs, wherein interoperability and collaboration across multiple organizations in multiple-vendor environments is financially rewarding to providers and their health IT vendors. Demand for collaboration and interoperability is best driven by underlying business models and business cases supported by regulation and oversight.
Guest post by Paul Smith, management consultant, North Highland.
Paul Smith
Information collaboration is not new, but there is an increasingly critical need for effective collaboration to create an efficient healthcare ecosystem. How can healthcare organizations design collaborative frameworks that allow them to successfully manage vast amounts of data and create actionable information from that data?
One of the first, and perhaps most important steps, is to understand why it’s imperative to foster an environment that encourages and promotes information collaboration. The amount of data companies use to track performance can be overwhelming, and many companies are inclined to abandon their quest to connect results across the organization, particularly when redundant data sources conspire across the enterprise to prevent a single source of truth. While it’s easy to understand why it happens, this approach can inhibit an organization’s ability to address the management of its data.
The implementation of an effective, collaborative framework is imperative. Not only does it have short-term impact, like enforcing consistent data quality and use, but it also improves business results. Active collaboration can lower management costs and enhance an organization’s ability to analyze and interpret information over the long haul and:
Improves the user experience for management, physicians, nurses, and patients
Reduces data inaccuracies and redundancies
Offers impact analysis across the organization for change requests
Enhances the organization’s ability to drive insight analysis and action creation based on a balanced information asset environment
Furthermore, if a healthcare organization chooses not to enforce a collaborative information framework, there may be financial consequences. Inconsistency in reporting can lead to noncompliance with provisions of the Affordable Care Act, which require uniform reporting and analytics.
Interoperability Accelerator
What’s really at stake? One example of the potential damage insufficient collaboration can create is evidenced in North Highland’s recent work with a healthcare organization that wanted to improve its management environment. During the onboarding process, new requirements and analytics were captured and documented. The requirements were then coded, tested and deployed prior to completion of the data loads. The missing component was an understanding of the impact that those changes had to legacy analytics in use across the client’s enterprise. As a consequence of no established metadata environment, changes made to the analytical applications impacted numerous analytics and reporting downstream- resulting in massive rework. North Highland worked to remediate data continuity throughout the effected systems and establish a scalable metadata framework to grow analytical capabilities with the future needs of the organization.
This example underscores why it is imperative to implement a model that addresses and improves interoperability, collaboration, and information knowledge, which eliminates a significant amount of risk and creates a highly effective information collaboration governance program.
One successful model that can be followed to address this issue emphasizes a business first approach and requires that there is an overall culture of collaboration both internally and externally. It is based on three fundamental disciplines and supported with metadata foundation that connects and maintains the relationships between the three disciplines. The model’s pillars include:
The Business Information Discipline (BID), which defines the data and information necessary to support the operational goals of each department, business unit or division within the organization. Roles and responsibilities within the BID vary based on the size of the organization, but certain roles are central to the discipline.
The Systems and Network Discipline (SND), which defines the system roles and network analyst roles within the information environment. This is the discipline with the largest concentration of technical resources, each having a degree of stewardship responsibility.
The Information Asset Discipline (IAD), which is responsible for creating, maintaining and delivering information asset management for the organization. IAD outlines governance implementation, stewardship roles and general management of information, enabling impact analysis across the organization.
Organizations must respond to healthcare laws and adapt business models to comply with necessary requirements, all the while continuing to monitor reform-related legislative changes and regulatory guidance. By following the outlined framework, healthcare organizations can create an unbreakable foundation that ensures consistency in data and enhances enterprise agility.
Guest post by Num Pisutha-Arnond, managing partner, Curas, Inc.
Num Pisutha-Arnond
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.
Health data security and patient engagement are top priorities for the nation’s hospitals, according to results of the 17th annual HealthCare’s Most Wired Survey, released today by the American Hospital Association’s Health Forum and the College of Healthcare Information Management Executives (CHIME).
The 2015 Most Wired survey and benchmarking study, in partnership with CHIME and sponsored by VMware, is a leading industry barometer measuring information technology (IT) use and adoption among hospitals nationwide. The survey of more than 741 participants, representing more than 2,213 hospitals, examined how organizations are leveraging IT to improve performance for value-based healthcare in the areas of infrastructure, business and administrative management, quality and safety, and clinical integration.
According to the survey, hospitals are taking more aggressive privacy and security measures to protect and safeguard patient data. Top growth areas in security among this year’s Most Wired organizations include privacy audit systems, provisioning systems, data loss prevention, single sign-on and identity management. The survey also found:
96 percent of Most Wired organizations use intrusion detection systems compared to 85 percent of the all respondents. Privacy audit systems (94 percent) and security incident event management (93 percent) are also widely used.
79 percent of Most Wired organizations conduct incident response exercises or tabletop tests annually, a high-level estimate of the current potential for success of a cybersecurity incident response plan, compared to 37 percent of all responding hospitals.
83 percent of Most Wired organizations report that hospital board oversight of risk management and reduction includes cybersecurity risk.
“With the rising number of patient data breaches and cybersecurity attacks threatening the healthcare industry, protecting patient health information is a top priority for hospital customers,” said Frank Nydam, senior director of healthcare at VMware. “Coupled with the incredible technology innovation taking place today, healthcare organizations need to have security as a foundational component of their mobility, cloud and networking strategy and incorporated into the very fabric of the organization.”
Telemedicine initiatives may have a promising future within the American healthcare system, and could alleviate the shortage of general practitioners, increase reliable access to basic and preventative care, and reduce overall costs. Despite potential positive outcomes of telemedicine platforms, patients remain dubious about this remote option and the quality of diagnosis made during virtual appointments.
According to a nationwide study conducted by TechnologyAdvice Research, nearly 65 percent of respondents said they would be somewhat or very unlikely to choose a virtual appointment, while only 35.4 percent stated the opposite. Approximately 75 percent of people reported they either would not trust a diagnosis made via telemedicine, or would trust this method less than an in-doctor visit.
Cameron Graham
“This is perhaps the largest issue that telemedicine vendors and healthcare providers will need to overcome,” said Cameron Graham, managing editor at TechnologyAdvice and the study’s author. “If patients don’t trust the diagnoses made during telemedicine calls, they may ignore the advice given, fail to take preventative steps, or seek additional in-person appointments, which defeats the point of telemedicine.”
Telemedicine is a newer technology in the medical industry, with greater lack of familiarity, but data from the study shows that younger patients may be less skeptical. Only about 17 percent of 18- to 24-year old respondents, and 24 percent of 25- to 44-year olds, said they wouldn’t trust a virtual diagnosis. Also, 65 percent of respondents said they would be somewhat or much more likely to use a virtual appointment system if they had first seen the doctor in-person.
With consumer use of wearables, smart pill bottles, health apps and other forms of personalized health technology rapidly increasing, concerns around data privacy, proper interpretation of health information and data stewardship are also on the rise. In response, the Vitality Institute, along with Microsoft Corporation, the University of California, San Diego, and other stakeholders, are developing a set of industry guidelines to address the legal, social and ethical concerns associated with the development and use of the technology and the data it generates. The guidelines build on existing best practices to create a standardized approach. A draft of the guidelines is being released online today, opening a three month public comment period before the guidelines are finalized.
“I urge anyone with an interest in the future of health technology to review the guidelines and comment. This includes consumers who use wearables, smartwatches and health apps, along with leaders of the companies that develop, market and distribute these products,” said Derek Yach, executive director of the Vitality Institute and senior vice president of the Vitality Group. “Personalized health technology has great potential to benefit the health of countless individuals and it is critical that we proactively address these legal, social and ethical challenges so that potential benefit is not hindered.”
The draft responsibility guidelines make six recommendations that call on personalized health technology to:
Protect the privacy of a user’s health data
Clearly define who owns a user’s health data
Make it easy for users to accurately interpret their data
Integrate validated scientific evidence into product design
Incorporate evidence-based approaches to health behavior improvement
HIMSS is now accepting nominations for awards and scholarships that recognize significant professional contributions to the field of health IT, from outstanding leadership in industry service, service to HIMSS, chapter activity, and publications. Online nominations for both awards and scholarships will be accepted through Friday, August 28 at 5 p.m. CT.
Awards: Award recipients are volunteers and leaders in the field who have contributed to the improvement of healthcare through the use of information and management systems. In 2015, 12 awards will be given in the following categories:
“I joined HIMSS in 1988 for professional growth and networking. HIMSS allows me to further health IT adoption for providers in Nebraska,” said Kevin Conway, Nebraska chapter, 2014 HIMSS Chapter Leader of the Year Award Recipient.
Scholarships:The HIMSS Foundation and HIMSS chapters annually awards scholarships to HIMSS student members who have achieved academic excellence and have potential as future leaders in the healthcare information and management systems industry. The 2015 scholarships include:
Sherpaa connects employees directly with doctors and insurance guides online to reduce healthcare costs. Founded in 2012, Sherpaa has redefined the healthcare experience for companies and employees across the country. Sherpaa powers its medical practice in the cloud with dedicated board-certified physicians and insurance navigators. It saves time and money by solving 70 percent of issues without routing them through the traditional healthcare system – fewer interactions with the healthcare system means greater efficiency for the individual and savings for the employer, Sherpaa currently “takes care” of more than 120 companies including Tumblr, Etsy and GLG.
Dr. Jay Parkinson
Sherpaa was co-founded by Dr. Jay Parkinson MD, MPH, trained in pediatrics and preventive medicine at St. Vincent’s and Johns Hopkins. He’s given talks for TED and The Clinton Global Initiative. He’s been referred to as “The Doctor of the Future.”
Marketing/promotion strategy
We are a B2B company selling into the HR and C-suite. Our founders are a doctor and an experienced HR expert leading up a proven sales team. We know firsthand what companies need, how they make decisions, and how to sell into them. As one of the few employer-driven healthcare services actually founded by a physician, our thought leadership in the space enables us to speak at conferences, produce interesting content, and truly have a respected voice in what the future of healthcare looks like.
Market opportunity
Our sweet spot is companies with 100 to 1,000 employees. Every single company of this size is struggling with out of control healthcare expenses without the in house resources to do anything about these skyrocketing costs. They’re being sold wellness plans that don’t work to control costs and traditional telemedicine services that can’t control costs when only 3 percent of a company uses them. They need a better solution that people will actually use. Without meaningful usage, costs can’t be contained. Unfortunately we’re lumped into the telemedicine space and people confuse us as being in competition with TelaDoc, American Well, Doctor on Demand, and MDLive. Sure, they sell into the same HR departments, but offer a service that nobody uses, and therefore can’t move the needle on healthcare costs. Presently, there is no other service in America available to companies that operates like Sherpaa, gets 70 percent of a company to use our services, and delivers the kind of results that we do.
With consumer use of wearables, smart pill bottles, health apps and other forms of personalized health technology rapidly increasing, concerns around data privacy, proper interpretation of health information and data stewardship are also on the rise. In response, the 
HIMSS is now accepting nominations for awards and scholarships that recognize significant professional contributions to the field of health IT, from outstanding leadership in industry service, service to HIMSS, chapter activity, and publications. Online nominations for both awards and scholarships will be accepted through Friday, August 28 at 5 p.m. CT.