As we head into Christmas, and 2015, millions of Americans have hopes for a bright holiday willed with hope, health and happiness. And while America’s consumer engine is in full force, presents are getting bought, wrapped and covered with ribbons and bows, it’s hard to image that there’s little that can’t be bought and given in the spirit of good cheer for the betterment of man and for the greater good. But, as in all areas of life there are a few things that won’t fit nicely in the stocking or under the tree.
If only everything we wanted and needed could be placed in our stocking to be unwrapped on Christmas morn, but there’s just too much on the list. The list would be long for those in healthcare – interoperability, improvement of policies, better communication with care providers, and even more, qualified employees to join healthcare-related ventures.
If only some of these Christmas wishes could be packaged and stuffed in the stocking. Here are a few ideas from several healthcare folks who wish they could make the world’s dreams come true.
Allen Kamrava, MD, MBA, attending staff, Cedars Sinai Medical Center, Department of Surgery, Division of Colorectal Surgery
Common language between all healthcare electronic health records (EHR) systems, such that they can communicate with each other and patient notes may be accessed between all providers. We have gone digital, but none of the systems communicate with one another. This does not make any sense. Patients should be able to elect to have their records “shared” between systems when they visit other physicians, and more so to have their accounts sync’d between systems so that all physicians are up to date with all tests, procedures and visits. For now, the only thing EMRs have provided for is more legible notes that are inundated with information required by national standards regulations. Healthcare is far beyond the rest of the IT world. Indeed, it functions in the pre-internet era – we have electronic systems, but they do not communicate in any meaningful way. Healthcare IT is still functioning as if we are in the 1990s.
Bill Marvin, president, chief executive officer and co-founder, InstaMed
Bill Marvin
Health IT Christmas wish: Interoperability. By integrating technology and processes across heterogeneous environments, providers automate administrative processes and simplify compliance requirements, resulting in lower operational costs.
I would love to see a fully functional telemedicine capability in every hospital and office across the country. What I mean by fully functional is that reimbursement hurdles have been cleared, apps are standard, we have a maturity and adoption model in place all so that patients are receiving the best care from the right clinician in the most optimal manner possible.
Charles Settles
Charles A. Settles, product analyst, TechnologyAdvice
There are a myriad of things I’d like to find in my figurative “stocking” come Christmas morning, but perhaps the one I’d like to see the most is more widespread patient, provider and payer use of health wearable devices or fitness trackers, i.e. Fitbit, FuelBand, Jawbone, etc. The spread of these devices is something we are keeping a close eye on here at TechnologyAdvice; we recently surveyed nearly 1,000 adults about their use of fitness trackers and uncovered several key insights. Perhaps the most actionable of those insights was that nearly 60 percent of adults would use a fitness tracking device if it would help reduce their monthly health insurance premiums. Of course, there are potential benefits to payers and providers as well — in the push to switch the healthcare reimbursements from a fee-for-service to a outcomes-based model, these devices could provide invaluable information to physicians that would aid in health maintenance, preventative care, and overall population health modeling. As these devices evolve and are able to track more and more biometrics, they could enable less expensive and higher quality telemedicine.
In its annual top health industry issues of 2015 report, PwC’s Health Research Institute (HRI) anticipates that the $2.8 trillion U.S. healthcare sector will start feeling like a true market. HRI’s report explores the top 10 trends that are expected to shape the sector in 2015, including the expansion of do-it-yourself healthcare, how industry will adapt to the newly insured, and consumers’ competing desires for convenience and privacy. Top health industry issues of 2015 include insights from a survey of 1,000 U.S. consumers and interviews with health industry leaders.
“With consumers leading the way, bearing more costs and making more decisions, change is erupting throughout the health industry,” said Kelly Barnes, PwC’s U.S. health industries leader. “Established healthcare companies and new entrants are rapidly developing cost-efficient products and services tailored directly to consumers.”
HRI’s top 10 issues for the health industry in the year ahead:
1. Do-it-yourself healthcare
U.S. physicians and consumers are ready to embrace a dramatic expansion of the high-tech, personal medical kit. Wearable tech, smartphone-linked devices and mobile apps will become increasingly valuable in care delivery.
2. Making the leap from mobile app to medical device
A proliferation of approved and portable medical devices in patients’ homes, and on their phones, makes diagnosis and treatment more convenient, redoubling the need for strong information security systems.
The College of Healthcare Information Management Executives (CHIME) is reiterating its call to immediately shorten the reporting period for 2015, as substandard meaningful use low Stage 2 attestation numbers lag for the 2014 program year, the organization said in a statement.
According to the data recently released by the Centers for Medicaid and Medicare Services (CMS) during the Health IT Policy Committee meeting, less than 35 percent of the nation’s hospitals have met Stage 2 meaningful use requirements. While eligible professionals (EPs) have until the end of February to report their progress, just 4 percent have met Stage 2 requirements thus far, CHIME cited.
“Despite policy efforts to mitigate a disastrous program year, today’s release of participation data confirms widespread challenges with Stage 2 meaningful use,” said CHIME president and CEO Russell P. Branzell, FCHIME, CHCIO.
Roughly one in three hospitals scheduled to meet Stage 2 in 2014 had to use alternative pathways to meet MU, administrative data current through December 1 indicates.
“This trend demonstrates how vital new flexibilities were in 2014 and again, underscores the need for the same flexibility in 2015,” said Branzell. “It is imperative officials take immediate action to put this critical transformation program back on track. Shortening the time frame for MU reporting in 2015 will help to ensure the program delivers on its promise to advance the transformation of healthcare in this country.”
CHIME and several other national provider associations have repeatedly told CMS that without more program flexibility and a shortened reporting period in 2015, the future of Meaningful Use is in jeopardy.
It’s obvious from the varying responses below that there are a plethora of health IT issues affecting a number of areas in and throughout hospitals. In reviewing a number of healthcare issues, the following thought leaders offer what they feel are the top IT issues in healthcare.
As is often the case in profiles such as this, the responses are diverse and varied. Do you agree with their assessments?
I work with hospitals nationwide and I find that the top issues facing the hospital are:
1. How to align the interests of the physician with the hospital in a world where the hospital takes risk? Physicians used to get paid by “time and material” in the old world and the hospital got paid by “contracted costs.” The new reality has both the physician and the hospital getting paid a fixed amount to then manage the cost of healthcare on a “fixed price” for lack of a better word. IT challenges: The tools in the “time and material” world are unsuitable to manage the new reality in a “fixed price” world. This is a top challenge.
2. Real-time P & L — If you ask a hospital CFO what the profitability of the current patients in Unit 10, they would give you a blank stare. This is because the do not know what they are going to get paid (the DRG or diagnosis-related group reimbursement) much less what their current costs are. Thus, the lack of visibility into managing costs creates havoc. IT challenges: Systems that can develop a view into costs and projected revenue require a lot of specialized people to provide the information even in hospitals that have a partial solution. Most hospitals do not know where to turn for new ways of thinking. This is a big IT challenge.
Doug Nebeker, owner and technical expert, Power Admin LLC Staying on top of compliance and auditing tasks is a top issue facing hospital IT departments today. As more and more data moves into the digital space, IT departments can easily become overwhelmed as staff gets bogged down with the tedious task of trying to keep track of what’s happening where in the system. Network monitoring software is seeing a boom as a result, quickly becoming an IT necessity for managing increasingly complex network auditing and compliance processes. Technology is meant to help, not hinder, and so as we continue to utilize it in new ways we must ensure our process management keeps pace.
Hospitals and other healthcare organizations will always have the need to exchange “unstructured” data. While there is a large focus on meaningful use, ICD and other mandates, many hospitals and organizations are not taking into account the need to quickly, affordably and securely transmit unstructured data while also staying HIPAA compliant. One of the main issues is that public cloud services are not HIPAA compliant. Healthcare organizations can work around this by extending their existing fax server solutions to the hybrid cloud, allowing both custom and popular EHR applications to communicate with each other via a private secure network, guaranteeing delivery with military grade end-to-end encryption. By eliminating the need for costly and cumbersome network fax systems, such as fax boards and recurring telephony fees, hospitals can leverage the hybrid cloud to swiftly manage all business-critical fax communications while staying HIPAA compliant.
David Finn
David S. Finn, CISA, CISM, CRISC, ISACA professional influence and advocacy committee member, health IT officer, Symantec
Healthcare is undergoing fundamental changes in reimbursement, care delivery models and the technology required to make these changes. Technology and information is no longer an adjunct to the business of healthcare — it is a strategic imperative. This information, however, is among the most regulated and protected information under the law. The data must be shared more widely with more people and organizations, all the while with stricter security and privacy controls. At a high level, the most critical issues facing health IT are:
1. Security and Privacy
Healthcare, historically, has not invested in nor staffed appropriately in terms in of Privacy and Security. Providers and business associates need to catch up with other regulated industries and those targeted for the value of their data.
2. Data Management
The digitization of healthcare has led to the massive collection of data. As healthcare becomes more dependent on this data, the storage, protection, back-up and recovery of the data is critical. It must include disaster recovery/business Continuity.
3. Interoperability and Information Exchange
Affordable Care Organizations (ACO), health information exchanges (HIE) and new care delivery models (home care, remote monitoring and other requirements) will drive information exchange.
Guest post by Daniel Piekarz, Vice President of Business Development, Life Sciences, DataArt.
mHealth is a broad category of healthcare technology including medical, health and wellness applications and devices. The mHealth market is exploding because of the vast interest in the space and a relatively low cost of entry. We are seeing the marketplace grow at a very rapid pace with likely more than 100,000 apps available on the market today.
Why is there so much excitement around the mHealth market? The platform that mHealth runs on has expanded around the entire globe with nearly 7 billion mobile phone subscriptions worldwide. This is equal to more than 95 percent of the world’s population as estimated by The International Telecommunication Union. This 7 billion includes 1.75 billion smartphone users globally, according to eMarketer. The world is more connected today than ever before and this has laid the foundation for the mHealth market to begin its climb into the mainstream.
But is the market ready?
In many ways the excitement in the market reminds me of the excitement that swarmed during the early 90s regarding the Internet. Every company was entering the space, trying all sorts of new business models and many companies were simply copying others trying to get in on the action. Unfortunately, as we saw with the Internet bubble, high levels of excitement around technology without a clear focus on the problem we are trying to solve can cause very expensive mistakes.
While government and patients are pushing for change in healthcare, a survey by PriceWaterhouseCoopers reveals doctors are less optimistic and more resistant to the disruption mHealth holds for their traditional roles. Only 27 percent encourage patients to use mHealth applications to become more active in managing their health; 13 percent actively discourage mHealth and 42 percent of doctors worry that mHealth will make patients too independent, and it seems to be the younger doctors who are the most worried, with 24 percent of them discouraging mHealth use.
The results of the PwC survey reflect what I have seen when discussing mHealth with doctors. The fear that patients will try to diagnose themselves, the fear of a relatively unregulated market and the lack of evidence-based information, a general fear of change. Yet the same survey states that 60 percent of doctors and payers feel that the wide adoption of mHealth is inevitable in the next few years.
Guest post by Rodney Hawkins, general manager, Diagnostic Solutions, Nuance Communications.
Over the past few years, we have seen the healthcare industry shift toward cloud-based services to improve workflow, patient care and access to information. In fact, a 2014 HIMSS Analytics Survey estimates 80 percent of healthcare providers use the cloud to share and store information today. A cloud network allows physicians, referring providers and specialists at many different sites to simultaneously and securely access patient information in real-time on any Internet-connected device to provide urgent care to patients. This technology is changing how information is exchanged to meet the needs of both physicians and patients. Specifically, using cloud-based services for medical image and report sharing can be a game changer when it comes to advancements in quality of care.
Patient care before the cloud
The best way to explain the benefits of cloud-based image and report sharing is to look at life without the cloud. For providers not using this technology, medical images are stored on a physical CD, and the patient is responsible for carrying it from facility to facility – or, even worse, providers rely on couriers and the postal service to ship discs (which takes days and delays patient care). Most physicians will attest that 20 percent of these CDs are lost, forgotten or corrupt. When this is the case, not only is all the information stored on the CD lost, but time and money is wasted having to repeat the imaging procedure.
Josh Pavlovec, PACS administrator at Children’s of Alabama describes the challenges physicians faced to read CDs before the facility moved to a cloud-based image exchange. “In the middle of the night, if a trauma surgeon needed someone to look at a CD that couldn’t be opened properly, that surgeon or a resident, would physically run the patient’s CD down the street, knock on doors and find a radiology resident to view that study; and then run back to their OR and start treating the patient.”
Another challenge arises when a complete profile is not made available to the entire patient care team. For example, if a patient is sent by a primary care physician to a larger hospital for an exam, and the hospital sends the patient to an outside specialist – that specialist will likely not get the patient’s full medical history, and will certainly not receive that information prior to the patient’s arrival. Children’s emergency physician, Dr. Melissa Peters explains, “Having the reading that’s associated with the transferred images is something that’s very helpful to us. When we have a child that’s transferred, our pediatric radiologists interpret the films, and they need the reading from the other facility in order to create a comprehensive report.”
The absence of readily available images and reports creates silos of patient information within healthcare leading to costly delays and repeat testing and, limiting the quality and efficiency of care provided by teams.
Dan Ward is VP of revenue integrity at MethodCare, now part of ZirMed.
To better understand the fundamentals of predictive analytics — and why it has the potential to transform healthcare — it can be helpful to use Netflix as an illustrative example.
Let’s say, for example, you’re sitting around the house one rainy October Saturday and decide to view a few movies using Netflix’s streaming service. First you watched Field of Dreams then you decided, hey, this rain isn’t letting up any time soon, and that dog doesn’t want to go out in it any more than I do. So, after a brief backyard sojourn during which you and the dog confirmed that 38 degrees and rainy is in fact unpleasant — you reconvened your Netflixing and ended up watching Bull Durham, as well. Further, let us also assume that you enjoyed both movies and watched them all the way through.
As the credits rolled on Bull Durham, the critical question for Netflix was the same it always is: What would you enjoy watching next — specifically, what should Netflix recommend? Based upon the day’s viewing you may have a soft spot for baseball movies. Though it could just as easily be the case that you’re Kevin Costner’s biggest fan and the fact that you queued up two of his baseball movies was pure coincidence.
Given the uncertainty orbiting these pieces of information, maybe the best prediction would be Dances with Wolves, starring Kevin Costner. Or maybe the right pick would be Moneyball, the story of how the Oakland A’s leveraged data-driven, evidence-based sabermetrics to remain competitive against much more highly capitalized MLB teams. But what if neither Kevin Costner nor baseball is the most important correlation—what if the best predictor of whether you’ll like a film is simply whether it’s a sports movie from the late 80s?
As with all forms of predictive analytics, the question of what to recommend multiplies in complexity as overlapping variables (often in the form of unstructured data) are added and subsequently considered within algorithmic equations that power, in this case, Netflix’s recommendation engine. Further complicating the matter, it’s likely that you’re not the only person to have watched both of these films in close proximity and there are likely to be numerous “motivations” for such viewings across the population. It becomes apparent rather quickly the inherent challenge of something that seems, on the surface, as straightforward as a recommendation engine.
In healthcare we face these same kinds of challenges, just in a different form. The questions we ask are which gaps in care create the greatest risk for the patient, or which specific combinations of gaps in care correlate with readmissions—so that clinical outreach coordinators and other staff can prioritize whom to contact right away. We ask which types of claims are most likely to be under-coded or missing charges—so that organizations can make best use of finite resources like staff time and ensure the greatest positive impact on overall financial performance.
The recent DEA schedule change of hydrocodone prescription drugs has critical implications for prescribers, pharmacies and patients – not only for patients who are taking hydrocodone medications for chronic pain, but also for patients who experience new injuries that require short-term pain treatment.
The following scenario depicts how the hydrocodone schedule change can impact all of these stakeholders:
A patient goes to see her primary care physician because she twisted her knee in an exercise class and can barely walk. During the examination, the physician determines that the patient has torn her ACL and will need a referral to an orthopedic surgeon for further examination and treatment. In the meantime, however, the physician is going to prescribe the patient Vicodin, a common pain medication, which has recently been reclassified as a Class II drug under the DEA’s schedule change.
Sounds like a pretty common story, right? But as simple as this scenario sounds, there are multiple challenges that can arise when physicians don’t have the right tools to do their jobs efficiently.
The first potential problem has to do with the referral. The method a physician uses to refer patients to specialists matters – a lot. Paper-based referrals can cause a number of problems, from insufficient information provided to specialists, to lack of timely feedback to referring physicians, to inefficient referral tracking.
Electronic referral management through the use of electronic health records (EHR) solves potential issues with timeliness and tracking. But whom a physician selects to refer a patient to is also critical. In today’s value-based model of healthcare, careful selection and management of physician referrals is integral to improving patient outcomes and reducing healthcare costs. And one of the best ways to maximize physician referrals is to use an accurate physician directory, or database, that contains vital information like location, ZIP code detail, affiliations, areas of specialty, and organizational capabilities.
